Membership Area Church Membership Information Card Name *FirstMiddleLastToday Date *Mailing Address: *City *Zip Code *Home PhoneCell PhoneEmergency PhoneBirth Date *Email Address *Please check all applicable boxes:Relation *SingleMarriedGender *MaleFemaleAdult/Child *AdultChildIf married, name of spouse: Reason for coming forward:Reason for coming forward: *To receive Jesus Christ as Lord & SaviorBecome a member by Christian ExperienceReaffirmation of Faith/Rededication of LifeRequesting prayer/IntercessionMinistries Previously Served in: (Check all that apply) Ministries Previously Served in *DeaconChoirBible TeacherEvangelismUsher/HospitalityTrusteeMediaAdministrationCulinaryDecision CounselorParking/SecurityOtherOtherHave you been baptized?YesNoOffice Use AddedBaptizedIf child, please complete below of cardThis is the child of:Parent/Guardian NameParent/Guardian RelationshipMotherFatherOther relationshipOther RelationshipIf different from childAddressCityStateZip CodeHome PhoneCell PhoneChurch Status *MemberVisitorPhoneSUBMIT REQUEST
