Membership

Your Name *

First Name

Last Name

Your Spouse's Name

(if applicable)

First Name

Last Name

Your Phone Number *

(###)

###

####

Your Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Birthday *

MM

DD

YYYY

Do we have permission to publish your name, number, address and email in our church directory?

Yes

No

Are you currently a member of another congregation? *

Yes

No

Who in your family has been baptized? *

Please check all that apply

I have been baptized

My spouse has been baptized

Some of my children have been baptized

All of my children have been baptized