If you meet the qualifications on the "To Participate Page" and would like to participate in CFCCM gatherings, complete this form and send the required information to the CFCCM registrar.

We will contact you within 30 days.

Purpose Statement:

As a Christ centered fellowship, we are committed together to provide encouragement for leaders of care center ministries. We do this through spiritual renewal, networking, fellowship, and sharing resources.

I would like to become a CFCCM participant:

Date ________________________________________________________
Name _______________________________________________________
Title ________________________________________________________
Name of Ministry ______________________________________________
Address _____________________________________________________
City / State / Zip ______________________________________________
Home Phone _________________________________________________
Work Phone __________________________________________________
Fax _________________________________________________________
Cell Phone ___________________________________________________
E-mail _______________________________________________________
Web address WWW.____________________________________________

Please be sure to enclosed the following:

• Four copies of your ministry's brochure
• A copy of your Vision/mission, values, statements
• A copy of your Statement of faith
• I you do not yet have an established nursing home ministry but have a specific vision and calling to do so, write out your general plans and goals. We would love to have you participate in our fellowship if your goals are in keeping with the rest of the fellowship.

Send to:
CFCCM Registrar
33399 Walker Rd. Suite A,
Avon Lake, OH 44012.