Faith Based Marketing Summit

FBMA Online Application

*Name of Organization:

*Key Contact:

*Title:

*Address:

*City:

*State:       *Zip:

Country (if not U.S.A.):

*Telephone:

Fax Number:

*Email Address:

*Website URL:

*Name of your local church:

*City/State of your local church:

*Reference #1 Email Address:

*Reference #2 Email Address:

*Reference #3 Email Address:

*Please describe your area of responsibility at your organization and how you feel you will profit from membership in the Faith Based Marketing Association:

*Membership type applying for:
Corporate Membership ($300)
Ministry/NPO ($175)

*Business/Ministry/Organization Type (check all that apply):

Non-Profit Organization (must have 501(c)(3))		Consultant
Ministry		Radio Media
Church		Television Media
For Profit Company selling faith-oriented products		Print Media
For Profit Company NOT selling faith-oriented products		Internet Media
Service Business		Agency
Other (please specify)

*Are you interested in a speaking engagement at FBMA events? Yes No

If yes, please describe your specific area of expertise/speaking topic:

IF NON-PROFIT ORGANIZATION OR CHURCH, PLEASE ANSWER THE FOLLOWING:

Type of non-profit organization:

Church		Christian Ministry
Advocacy		Humanitarian
Environmental		Health
Education		Children's Causes
Political		Other (please specify)

Is your organization a member of the Evangelical Council for Financial Accountability (ECFA)?
Yes No

*Do you currently use any form of faith based media? Yes No

If yes, what kind?

Radio		TV
Cable		Magazines/Newspapers
Internet		Other (please specify)

*=required

When you hit "submit" you will be redirected to a payment form for your non-refundable $50 application fee.

After this form has been received, emails will be sent to your three references containing instructions and a URL to It is your responsibility to ensure your reference forms are returned to the FBMA promptly. Applications/references that are not completed within 90 days of the application date will go to inactive status and an additional $50 application fee will be assessed to resume the application process.