Please fill in the fields below:

Title:

First Name:

Last Name:

Address:

City:

State:

Zip Code:

Phone:

Email Address:

Church Name & Address:

I have attended this church since:

Approximate Church Weekly Attendance:

My church offers small groups/cell groups:YesNo

My church is affiliated with a Christian High School.YesNo

Pastor's Name:

Yes, I have approval from my Pastor to serve as my CUFI Rep.YesNo

Pastor's Email Address & Phone Number:

Why do you want to serve as a CUFI Rep?

How did you get involved with CUFI?

Why do you support Israel?

As CUFI Church Rep, I intend to:

Check all that apply:Promote our Annual CUFI Washington Summit.
Assist our CUFI Coordinator in hosting an annual CUFI event
Assist our CUFI Coordinator in promoting area CUFI events
Work with other area CUFI Church Reps to promote a regional Night To Honor Israel
Nominate my Pastor be considered for a future CUFI Israel trip.
Help recruit HS/College students for CUFI on Campus.

Host our CUFI information table:MonthlyQuarterly

Work with my church's Small Group pastor to offer the Israel Course.I would like to lead the group.My Pastor would appoint a leader.

Background Check:

To assure a representative does not promote an anti-Israel, anti-Semitic agenda with intend to disrupt the purpose of this role or pose potential danger, CUFI performs background checks on applicants before approval.

Do you consent to a background check? Yes No -