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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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Signature field is empty.

Date*

Month

Day

Year

CHURCH ADDRESS

2629 Tunnel Blvd.
Chattanooga, TN 37406

Tel: 423-629-2875

Fax: 423-468-3507

Email: office@newunited.org

www.newunited.org

CONTACT US

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