First Name

Last Name

Phone

Email *

Address

Street Address

City

State

Postal Code

Where do you work, ex. hospital?

What is your speciality: ex. hospice?

How long have you been in practice?

Religious Affiliation

Age Group

Race Ethnicity (other is acceptable)

Would you like to join the military chaplain division of SCA?

YES

NO

Please list branch or “I am a civilian, but my service focuses on veterans.”

Do Not Forget to Attach

1. Certification

2. Proof certification is current and active - Letter or receipt or document from NACMC

About us

NACMC is a fraternal support and chaplain certifying agency that adheres to the Common Standards for Chaplains.

Stay in touch with us