WM Certification Seminar you anticipate attending:

      National seminar in southern California (Dec. 4, 2006)
      Regional seminar – Los Angeles / Orange County San Diego San Francisco / Sacramento Portland, OR Seattle Las Vegas Phoenix Dallas Houston Denver Minneapolis Chicago Detroit New Orleans Atlanta New York City Baltimore Cincinnati Pittsburgh St. Louis Miami Orlando
      Not sure

Are you already ordained?

      Yes
      No

If yes...

* Date ordained
January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940

* Ordaining institution

Do you currently perform weddings?

      Yes
      No

If yes, how many have you performed?
1-5 5-10 10-25 25-100 100-250 over 250

Any Church / Synagogue pastoral experience?

      Yes
      No

If yes, when?

• from 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 to 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940
• what denomination or faith?
  
• Name of church / synagogue,       city                                                      state
                         

Education – Years Completed

             less than H.S. High School / GED Some college Associate degree Bachelor degree Some post grad Master's Degree Other (specify below)
Other:

Degree(s) earned                 Date                                         Name of Institution

Current occupation:

Additional Questions:

1. What are your primary goals in becoming WM Certified? What do you hope WM Certification with help you accomplish? What knowledge, insights, and/or skills do you hope to gain?
   
    
2. Briefly describe what, if any, religious orientation or spiritual philosophy you most deeply hold to. What are your most deeply held beliefs or values?
   
    
3. Briefly describe the most significant, life-shaping events in your life. How did they change you? How are they central to who you are, what matters most to you, and how you now live?
   
    
4. What life experiences do you believe have best prepared you to be an effective wedding minister? How so?
   
    
5. Name one or two of the most influential people in your life. How have they inspired and/or impacted you?