Membership Form

Become A Member

First name

Last name

Multi-line address

Country/Region

Address

City

Zip / Postal code

Email

Phone

Birthday

Month

Day

Year

Marital Status

Single

Married

Divorced

Separated

Children

Yes (Give name and birthday, If they attend church with you and under the age of 18)

No

Child Name

Date of Birth

Child Name

Date of Birth

Child Name

Date of Birth

PREVIOUS CHURCH DETAILS

(Please give name and address of previous church, if applicable, for reference purposes)

Church Name and Address

Pastor Name

Were you a member of your previous church?

Yes

No

If Yes, Please Give Date

BAPTISM INFORMATION

Have You Been Water Baptised?

Yes

No

Date

Where

I confirm that to the best of my knowledge the above information is true. I understand that completion of this form without attending a membership class and receiving written confirmation does not constitute formal membership.

Signature

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Date

Month

Day

Year

Membership Form

Become A Member

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