This document is an application for an ID card for certified emergency response chaplains. It requests basic personal information such as name, address, date of birth, physical description, and signature. It provides instructions for submitting the completed application either by mail with two passport photos or by email with a digital photo. Guidelines are given for taking a proper photo to include with the digital submission.
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Operation Noah's Ark is a firm and proud supporter in assisting in the regulating Cyber Terrorism we have a O% tolerance to this types of activities among those who are involved in these acts.
Please call our toll free Hot Line to process your tax deductible gift giving donation today!
1-888-306-9679
2012 (c) Copy Right Operation Noah's Ark Corporation All Rights Reserved
Operation Noah's Ark is a firm and proud supporter in assisting in the regulating Cyber Terrorism we have a O% tolerance to this types of activities among those who are involved in these acts.
Please call our toll free Hot Line to process your tax deductible gift giving donation today!
1-888-306-9679
2012 (c) Copy Right Operation Noah's Ark Corporation All Rights Reserved
1. CERTIFIED EMERGENCY RESPONSE CHAPLAINS
I.D. CARD APPLICATION/RENEWAL
(Please Print Clearly)
Name:_________________________________________________________________________________
(Last) (First) (M.I.) Street
Address:__________________________________________________________________________
City:_______________________________________________ State:________ Zip:________________
E-mail Address:__________________________________________________________________________
Phone: (_______)________________________________ CERC & ERCC
HQ USE ONLY
Date of Birth:____________________________________
(YYYY) (MM) (DD)
Hair Color:___________________ Height:___________
Eye Color:___________________ Weight:___________
Signature:______________________________________ Date:_______________________________
Submission Option (1): Print this form. Fill in all information. Mail completed and signed form, 2 passport photo's
to (ERCC) to:
Chaplain (LTG) John D. Butler / ERCC/CERC
P.O. Box 3332
Kinston, NC. 28502-3332
Submission Option (2): Print form. Fill in all information. PDF or scan completed and signed form, and email
form and photo (JPEG format) to chaplain_andrew@yahoo.com.
Photo Option (1): Obtain passport photos from the Post Office, Walgreens, UPS, Wal-Mart or other commercial
vendor. Cost is approximately $9.00 for 2 photos. Mail 1 photo with completed and signed form to the address
above.
Photo Option (2): Provide a JPEG photo via email. If you choose this option you MUST strictly adhere to the
following guidelines:
Take the photo against a plain white or off-white background
Photo must be full face, front view from top of head to just below the shoulders
Face in photo should have a natural expression; eyes open, mouth closed, not smiling
Wear a light colored (white preferred) button-up dress shirt/blouse with top button open
No clergy attire, uniforms, sunglasses, hats or scarves permitted