Retired Status Request Form All board certified or associate certified chaplains in the Association of Professional Chaplains who are is in good standing, have been certified for at least two years, and who are retired from professional chaplaincy may request retired status. Retired status applies to those who have substantially retired from the profession of chaplaincy and who work no more than 50% of the time within a year in professional compensated chaplaincy. Certification or status with BCCI does not change, hence the use of the terms “Retired Board Certified Chaplain” and “Retired Associate Certified Chaplain.” Note: Maintenance of BCCI Certification fees, annual continuing education reports, five-year peer reviews and five-year spiritual/faith group endorsements are NOT required of retired board certified chaplains or retired associate certified chaplains. If you would like to request this status change, please fill out the Retired Status Request Form below, within the month of your retirement date. Please do not submit this form prior to the month of your retirement date.Member InformationIndicate certification type(Required) Board Certified Chaplain (Retired) Associate Certified Chaplain (Retired) SalutationMr.Ms.Mrs.ChaplainRev.RabbiFatherSisterBrotherImamDr.Rev. Dr.CH (MAJ)CH (COL)DeaconessPastorName(Required) First Middle Last Home Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern 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CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Phone Type(Required)HomeMobileWorkE-mail(Required) Faith Group(Required)2/42 Community ChurchAbundant Life CenterAcademy for Jewish Religion/California LocationNot Affiliated with New YorkAdvent Christian ChurchAfrican Methodist Episcopal ChurchAfrican Methodist Episcopal Zion ChurchAgape Christian CenterALEPH: Association of Rabbis and Cantors for Jewish RenewalAlliance for Renewal ChurchesAlliance of BaptistsAmazing Grace Deliverance ChurchAmerican Assn of Lutheran ChurchesAmerican Baptist AssociationAmerican Baptist Churches USAAmerican Carpatho-Russian Orthodox DioceseAmerican Conference of CantorsAmerican Council of Christian ChurchesAmerican Ethical UnionAmerican Evangelical Christian ChurchAmerican Evangelistic AssociationAmerican Muslim Armed Forces & VA CouncilAmerican Old Catholic ChurchAmerican Orthodox CatholicAncient Dragon Zen GateAnchor FellowshipAnglican Catholic ChurchAnglican Church of CanadaAnglican Church in North AmericaAnglican Mission in AmericaAnglican Province of AmericaAnglican Rite Catholic ChurchAntioch Baptist ChurchAntiochian Orthodox Christian Archdiocese of North AmericaApostolic Catholic ChurchApostolic Church of GodArmenian Church of America (Eastern of Western Diocese)Ascension Alliance and Community of AscensionistsAssemblies of GodAssemblies of God International FellowshipAssociation of Evangelical Charismatic MinistriesAssociation of Evangelical Gospel AssembliesAssociation of Free Lutheran CongregationAssociation of Independent MethodistsAssociation of International Gospel AssembliesAssociation of Reformed Baptist ChurchesAssociation of Rabbis for Jewish RenewalAssociation of Soto Zen BuddhistsAssociate Reformed Presbyterian ChurchAssociated Gospel ChurchesAutumn Ridge ChurchB’nai Israel Reform TempleBaptist Bible Fellowship InternationalBaptist Convention of Hong KongBaptist Convention of Ontario and QuebecBaptist General Conference/Converge WorldwideBaptist General Convention of TexasBaptist General Convention of VirginiaBaptist Missionary AssociationBay Zen CenterBerean Christian ChurchBethel Fellowship InternationalBethel Ministerial AssociationBethel World Outreach Ministries International (BWOMI)Bible Church of Little RockBible Churches ChaplaincyBible Fellowship ChurchBible Presbyterian ChurchBible Way Church of Our Lord Jesus ChristBlessed Hope Bible ChurchBlue Cliff Monastery (Unified Buddhist Church)Board of Rabbis of Northern CaliforniaBoard of Rabbis of Southern CaliforniaBon Air Baptist ChurchBreckenridge Christian MinistriesBrethren in Christ ChurchBuddha Eye TempleBuddhist Churches of AmericaBulgarian Eastern Orthodox DioceseByzantine Catholic Eparchy (Falls under umbrella of Roman Catholic Church)Calvary Baptist Church (All Points Baptist Mission)Calvary Bible ChurchCalvary ChapelsCalvary Memorial ChurchCambridge Insight Meditation Center (CIMC)Canadian Baptists of Ontario and QuebecCantors AssemblyCapo Beach CalvaryCatholic Apostolic Church of AntiochCBAmerica a/k/a/Venture Church NetworkCedarCreek ChurchCedar Mill Bible ChurchCeltic Christian ChurchCenters for Spiritual LivingCentral Conference of American RabbisCentral Ohio Center for Pragmatic BuddhismCentral Valley Zen FoundationChabad of Orange / WoodbridgeChanging Lives Christian Center InternationalChoegar Gong BhumisparshaChaplaincy Institute (Interfaith Ministers)a/k/a CHI Interfaith CommunityChaplaincy of Full Gospel ChurchesCharismatic Episcopal ChurchChicago Board of RabbisChinmaya Mission WestChrist Apostolic Church (World Wide)Christ Catholic Church InternationalChrist Church of PeaceChrist Community ChurchChristian Brethren AssembliesChristian and Missionary AllianceChristian Churches and Churches of ChristChristian Communion International, Province USAChristian Evangelical Churches of AmericaChristian Faith Ministers FellowshipChristian Fellowship ChurchChristian Methodist Episcopal ChurchChristian Reformed Church in North AmericaChua Pho-TuChurch of Agape DiscipleshipChurch of Christ (Holiness) USAChurch of God (Anderson, IN)Church of God (Cleveland, TN)Church of God by FaithChurch of God in Christ (Memphis, TN)Church of God in Christ (Chicago, IL)Church of God in Christ InternationalChurch of God Militant Pillar and Ground of the TruthChurch of God MinistryChurch of God of ProphecyChurch of God, Seventh-dayChurch of Jesus Christ of Latter-day SaintsChurch of Our Lord Jesus Christ of the Apostolic FaithChurch of Park SlopeChurch of the BrethrenChurch of the Fellowship of All PeoplesChurch of the Living God, Inc.Church of the Lutheran Brethren of AmericaChurch of the Movement of Spiritual Inner AwarenessChurch of the NazareneChurch of the SaviorChurch of the United Brethren in ChristChurch Without Walls/The Hope CenterChurches of ChristChurches of Christ in Christian UnionChurches of God, General ConferenceCircle SanctuaryCoalition of Spirit-filled ChurchesCoastal Community ChurchCole Community ChurchColumbia Community Bible ChurchCommunion of Convergence ChurchesCommunion of Episcopal Convergence Churches USACommunion of Evangelical Episcopal ChurchesCommunity Bible ChurchCommunity Christian ChurchCommunity ChurchCommunity Church of GreenwoodCommunity Church of New ThoughtCommunity Church of New Thought / Int’l New Thought AllianceCommunity of Bible ChapelCommunity of ChristCommunity of Christian ChurchCongregation Anshe TikvahCongregation Beth AdonaiCongregation Beth JehudahCongregation Rosh PinaCongregational Christian ChurchesCongregational Holiness Church/North Georgia DistrictCongregational Methodist ChurchConservative Congregational Christian ConferenceConservative Lutheran AssociationConverge Worldwide/Baptist General ConferenceConvocation of Anglicans in North AmericaCooperative Baptist FellowshipCoral Ridge Christian FellowshipCovenant Blessing MinistriesCross Pointe ChurchCross Points ChurchCrossPointe ChurchCrossroads Community Church of James Island, SCCumberland Presbyterian ChurchDallas Meditation CenterDeliverance Temple of Truth Holy ChurchesDharma Ocean FoundationDharma Teacher OrderDisciples of ChristDisciple Renewal Inc./Disciple Heritage FellowshipDivine Expression International MinistriesDo Ngak Kunpren Ling (DNKL) Tibetan Buddhist CenterDOVE Christian Fellowship InternationalDzongsar Jamyang Khyentse (Kagyu Changchub Chuling)Eastern Star ChurchEastern Orthodox ChurchEbenezer Temple Pentecostal ChurchEckankarECO: Covenant Order of Evangelical PresbyteriansEcumenical Catholic CommunionElim FellowshipElmbrook ChurchEmerson Institute (for Religious Science)Episcopal ChurchEpiscopal Missionary ChurchEvangel Fellowship InternationalEvangelical Anglican Church in AmericaEvangelical Chaplains Commission a/k/aNational Association of Evangelical ChaplainsEvangelical Church AllianceEvangelical Church of North AmericaEvangelical Church Winning All USAEvangelical Congregational ChurchEvangelical Covenant ChurchEvangelical Episcopal ChurchEvangelical Free Church of AmericaEvangelical Friends InternationalEvangelical Lutheran Church in AmericaEvangelical Lutheran Church in CanadaEvangelical Lutheran Church of Hong KongEvangelical Methodist ChurchEvangelical Presbyterian ChurchExtraordinary Lutheran MinistriesFaith Christian Fellowship InternationalFaithful Central Bible ChurchFamily Discipleship MinistriesFamily of GodFederated Orthodox Catholic ChurchesFederation of Christian MinistriesFellowship Bible Church of NWAFellowship Bible Church/DallasFellowship of Grace Brethren ChurchFellowship of Independent Reformed Evangelicals (FIRE)Fellowship of the SpiritFire Baptized Holiness Church of God of the AmericasFirst Baptist Cathedral of WestburyFirst Bible Baptist Denomination of EgyptFirst Christian ChurchFirst Church of Christ, ScientistFive Mountain Zen OrderForest Hill ChurchFort Bend Community ChurchFoundations International MinistriesFountain of Hope Praise and Worship MinistryFree Methodist Church of North AmericaFree Spirit Missionary Baptist ChurchFree Will BaptistsFree Wesleyan Church of TongaFull Gospel Baptist Church Fellowship InternationalFull Gospel Churches InternationalFull Gospel Fellowship of Churches and Ministers a/k/a Fellowship NetworkFull Gospel Pentecostal Association / ChurchFull Gospel World Missions, Inc.Fundamental Baptist Fellowship InternationalGeneral Association of General BaptistsGeneral Association of Regular Baptist ChurchesGeneral Baptist State ConventionGeneral Church of the New JerusalemGeneral Conference of Churches of GodGeneral Conference of Mennonite Brethren ChurchGethsemane Garden Wholistic Ministries, Inc.Golden Leaf Missionary Baptist ChurchGood Neighbor Baptist ChurchGrace Bible ChurchGrace Brethren ChurchesGrace Church of GodGrace Churches InternationalGrace Community ChurchGrace Community Church of Raleigh, Inc.Grace Covenant Church of RoanokeGrace Gospel FellowshipGrace International Church Inc. (Florida)Grace International Churches and Ministries (Texas)Grace Outreach Family ChurchGrace PlaceGreater Boston Zen CenterGreater Portland Bible ChurchGreek Orthodox Archdiocese of AmericaGreenville Christian Fellowship (GCF)Greenwich Reform SynagogueHarvest Bible Chapel Lake ZurichHarvest Christian FellowshipHarvest Point Fellowship ChurchHebrew CollegeHebrew Seminary of the DeafHigher Ground Always Abounding AssembliesHigher Ground International MinistriesHighlands ChurchHoly Catholic ChurchHoly Fire Ministry InternationalHoly Spirit Association for the Unification of ChristianityHoly Trinity Russian Orthodox ChurchHonolulu Diamond SanghaHope ChapelHorizon Christian Fellowship (DoD)Houston Zen Center (Association of Soto Zen Buddhists)Hue Lam Meditation CenterHumanist SocietyHungarian Reformed ChurchHusseini Islamic Centeri5 CityIFCA InternationalIndependent Assemblies of God InternationalIndependent BaptistsIndependent Christian ChurchIndia Pentecostal Church of Central FloridaIndian Pentecostal Church of GodInFaithInsight Meditation CenterInsight Meditation SocietyInterfaith Temple of New York CityInternational Alliance of Messianic Congregations & SynagoguesInternational Association of Grace MinistriesInternational Center of Chinese Buddhist Culture and EducationInternational Christian ChurchesInternational Church of the Foursquare GospelInternational Church on the RockInternational House of BishopsInternational Community of ChristInternational Convention of Faith MinistriesInternational Council of Community ChurchesInternational Fellowship of Bible ChurchesInternational Fellowship of Chaplains (IFOC)International Ministerial FellowshipInternational New Thought Alliance/Community Church of New ThoughtInternational Pentecostal Holiness ChurchInternational Rabbinic FellowshipInternational Society for Krishna ConsciousnessIsaiah 61 Ministries dba Calvary Community ChurchIslamic Society of N. AmericaIsrael Missionary Baptist ChurchJamal Community ChurchJesus Tabernacle of Deliverance Ministries (JTDM)Jewel Heart Tibetan Buddhist Learning CenterJewish Federation of Greater New HavenJewish Renewal MovementJewish Theological SeminaryJewish Welfare Board / Jewish CouncilJMG Enternational Prayerlife InstituteJourney ChurchJourney Imperfect Faith CommunityJoy World Universal ChurchJoyful Harvest Christian MinistryJudaism-ConservativeJudaism-OrthodoxJudaism-ReconstructionistJudaism-ReformKagyu Changchub Chuling (Dzongsar Jamyang Khyentse)Kingdom Fellowship Christian CenterKingdom Fellowship Covenant MinistriesKingdom Worship CenterKingsway Fellowship InternationalKnott Avenue Christian ChurchKorea Sha Buddhist TempleKorean Evangelical Church of AmericaKorean Presbyterian Church AbroadKorean Presbyterian Church of AmericaKorean-American Presbyterian ChurchKwan Um School of ZenLakewood ChurchLancaster Mennonite ConferenceLaSalle Street ChurchLatvian Evangelical Lutheran ChurchLiberal Catholic ChurchLiberating Word FellowshipLiberty Baptist FellowshipLiberty Fellowship ChurchesLife Discovery MinistriesLight of Christ Community ChurchLindisfarne Community (In Christ Ministries)Lives Changed by ChristLiving Waters Christian FellowshipLiving Water MinistryLogos Christian MinistriesLove Center MinistriesLutheran Church – Missouri SynodLutheran Congregations in Mission for ChristLutheran Evangelical Protestant ChurchLutheran Ministerium and Synod USAMaitripa CollegeMalankara Orthodox Syrian ChurchMangala Shri BhutiMariner's ChurchMar Thoma Church Diocese of North America & EuropeMasjid al Iman / Sufi OrderMasjid Malcolm Shabazz (Mosque)Masjid Ul MumineenMasterworks, Inc.Mennonite ChurchMethodist Church of MalaysiaMetro New York Adventist ForumMetropolitan Community ChurchesMid-America Buddhist AssociationMissio Dei Communities ChurchMission Valley Christian FellowshipMissionary BaptistMissionary Church, Inc. (NAE)Missionary Church InternationalMission MinyanMoedim Ministries and Academic Association Inc.Moody ChurchMoravian Church in AmericaMosaic Christian ChurchMountainview Christian ChurchMount Sinai Baptist ChurchMt. Zion Baptist Church of Greensboro, NCMuslim Endorsement Council, Inc.Myrtle Baptist ChurchNAJC – agent for Jewish Walfare Board (JWB)Nalandabododhi Buddhist ChurchNashville Zen CenterNative American Tribal LiaisonNational Association of Congregational Christian ChurchesNational Association of Evangelicals a/k/aEvangelical Chaplains CommissionNational Baptist Convention of AmericaNational Baptist Convention USANew Covenant Christian MinistriesNew Creation Church of San DiegoNew Gethsemane Baptist ChurchNew Hope Missionary Baptist AssnNew Horizon Gospel MinistriesNew Life Community ChurchNew Life Ministries, Inc.New ShulNew Thought Religious ScienceNew York Zen Center for Contemplative CareNichiren Order of North AmericaNorth American Baptist ConferenceNorth American Hindu Chaplains AssociationNorth American Lutheran ChurchNorth East Islamic Community CenterNorth Shore Chinese Christian ChurchOak Park Temple B’Nai Abraham ZionOceanview CommunityOld Catholic Church Province of USOld Holy Catholic ChurchOld Roman Catholic ChurchOne ChurchOne Spirit InterfaithOpen Bible ChurchesOrder of Buddhist ContemplativesOrder of Universal InterfaithOriginal Free Will Baptists ConventionOrthodox Anglican ChurchOrthodox Catholic Archdiocese, North AmericaOrthodox Christian, GreekOrthodox Church in AmericaOrthodox Presbyterian ChurchOSH Native American Tribal LiaisonOvercomers Ministries, Inc.Parkview Community ChurchPeace Presbyterian ChurchPentecostal Assemblies of the WorldPentecostal AssemblyPentecostal Church of GodPentecostal Church of God International MovementPentecostal Churches of the Apostolic Faith (DoD)Pentecostal Free Will Baptist ChurchPentecostal Holiness ChurchPentecostal Missions Church of GodPeople House CommunityPhilippine Independent Catholic ChurchPillars of Spiritual Ministry AssociationPirchei Shoshanim (Judaism)Plymouth BrethrenPolish National Catholic Church of AmericaPotter House/DallasPower Hope and Grace Bible ChurchPrayer and Faith Outreach MinistriesPresbyterian and Reformed Commission on Chaplains and Military PersonnelPresbyterian Church (USA)Presbyterian Church in AmericaPresbyterian Church in CanadaPresbyterian Church of East AfricaPresbyterian Church of KoreaPrimitive Methodist ChurchProgressive Christian AllianceProgressive National Baptist ConventionPundarika FoundationRabbinic Association of Greater MiamiRabbinical Alliance of AmericaRabbinical Assembly (Conservative)Rabbinical Council of America (Orthodox)Rabbinical Seminary InternationalRapha MinistriesReal Life MinistriesReconstructionist Rabbinical AssociationRedeemer Community ChurchRedemption Bible ChurchReformed Anglican Catholic ChurchReformed Church in AmericaReformed Episcopal ChurchReformed Presbyterian Church of North AmericaRegular Baptist Chaplaincy MinistriesReligious Naturalist AssociationReligious Science (Emerson Institute)Religious Society of FriendsReno Buddhist ChurchReservoir ChurchRestoration House InternationalRhema Bible ChurchRHEMA Ministerial Association International (RMAI)Rime Tibetan Buddhist CenterRisen ChurchRiver of Life Community ChurchRocky Mountain Rabbinical CouncilRoman Catholic ChurchRomanian Catholic ChurchRussian Orthodox ChurchRussian Orthodox Church Outside of RussiaRussian-Ukrainian Evangelical Baptist Union, USASacred Well Congregation InternationalSakya Monastery of Tibetan BuddhismSalvation ArmySanctuary FoundationSaraswati BhawanSatchidananda Ashram YogavilleSausalito Christian FellowshipScience of Man ChurchSeekers ChurchSeventh-day Adventist ChurchShadhliyya Sufi OrderShambhala / VajradhatuShanti Mandir Temple of PeaceSharon Fellowship ChurchShelbyville Community ChurchShiloh Christian ChurchShiloh Missionary Baptist ChurchShul (Judaism)Siburt Institute of Church MinistrySignal Mountain Church of ChristSikhismSkillman Bible ChurchSouthern Baptist ConventionSouthern Methodist ChurchSouthland Christian ChurchSouthlands ChurchSouthside ChurchSouthside Christian Church of MantecaSouthway Community ChurchSovereign Grace Baptist AssociationSpirit Rock Meditation CenterSpiritualistSravasti AbbeyStone Bridge ChurchStone Creek Zen CenterSuburban Christian ChurchSufi Order InternationalSufi Order International / Masjid al ImanSufi Order International / The Universal WorshipSufi Ruhaniat InternationalSummit ChurchSummit Unitarian Universalist FellowshipSuncoast Community ChurchSwedenborgian ChurchSword of the Spirit Christian FellowshipSyriac Orthodox Church of AntiochSyrian Eastern Orthodox ExarchateSyrian Orthodox Church in North AmericaTallahassee Chan CenterTemple Beth El of PatchogueTemple Bible ChurchTemple Emanu-ElTemple IsraelTemple MenorahTemple of the WatersTemple Shaaray TefilaTibetan BuddhistThe Other Church LancasterThe Well ChurchTown and Village SynagogueTrinity Fellowship ChurchTrinity Full Gospel FellowshipTwining Vines Zendo, Inc., d/b/a Twining Vines SanghaTwo Arrows Zen (Buddhist)Udumbara Zen CenterUkrainian CatholicUkrainian Orthodox Church, USAUnaffiliated Baptist Churches of AmericaUnified Buddhist Church, Inc.Unified Buddhist Church (Blue Cliff Monastery)Union of Messianic Jewish CongregationsUnitarian Universalist AssociationUnitarian Universalist Society for Community MinistryUnited American Free Will Baptist Conference, inc.United American Free Will Baptist ChurchUnited Anglican ChurchesUnited Brethren of Hebron SynagogueUnited Catholic ChurchUnited Christian FellowshipUnited Church of CanadaUnited Church of Jesus Christ ApostolicUnited Church of ChristUnited Church of Christ in JapanUnited Church of Religious SciencesUnited Episcopal Church of North AmericaUnited Full Gospel Church AssociationUnited Holy Church of AmericaUnited Metaphysical ChurchUnited Methodist ChurchUnited Missionary Baptist AssociationUnited Pentecostal Church InternationalUnited Presbyterian Church of BrazilUnity of the Brethren in TexasUnity Worldwide MinistriesUniversal Anglican ChurchUniversal Church of the MasterUniversal Fellowship of Metro Community ChurchesUniversal Life ChurchUniversal Worship / Sufi Order InternationalUpaya Zen CenterUpper Room International Christian FellowshipUpper Valley Zen CenterUS Conference of Mennonite Brethren ChurchesVajradhatu / ShambhalaValley Beth ShalomVenture Church Network a/k/a CB AmericaVictory Christian CenterVictory ChurchVietnamese Buddhist CommunityVietnamese Grace Baptist ChurchVillage Church (Bartlett, IL)Village Community MinistriesVillage ZendoVineyard USAVinings Lake ChurchVolunteers of AmericaWay of LifeWesleyan ChurchWestern Orthodox Christian ChurchWestside Christian Family ChapelWhite Robed Monks of St. BenedictWillow Creek North SideWilshire Boulevard TempleWisconsin Evangelical Lutheran SynodWoodmen Valley ChapelWoodside Bible ChurchWord of Life Christian CenterWorld Baptist FellowshipWorld Bible Way FellowshipWorld Congregational Fellowship ChurchWorld Council of Independent Christian ChurchesWorld Ministry FellowshipWorldwide Fellowship of Independent Christian ChurchesWorship CenterYakar InstituteYashiva UniversityYa’ya Guaili Ara Taino YukayekeYellow Springs HavurahZaltho Zen CommunityZen BuddhismZen Center of Los Angeles (ZCLA)Zen Community of OregonZen Peacemaker OrderLast Employer Position Date of Retirement Month Day Year Date of certification as a board certified chaplain or status as an associate certified chaplain:(Required) Month Day Year By typing my full name below, I understand that this form is to verify my retirement from full-time chaplaincy and my desire to become an associate certified chaplain (retired) or board certified chaplain (retired) in APC with full rights and privileges.Signature:(Required) Date:(Required) Month Day Year Payment InformationInvoice Information(Required) Please invoice me Please invoice my organization I have already paid this year’s dues – no payment necessary Payment Method(Required) Check Credit Card If paying by credit card, APC staff will be in touch to receive payment information. If paying by check, please make payable to Association of Professional Chaplains and mail to: Association of Professional Chaplains 2800 W. Higgins Rd., Suite 295 Hoffman Estates, IL 60169CommentsThis field is for validation purposes and should be left unchanged. Δ