The Power Center Discipleship Form

Spouse Name

First NameLast Name
Primary Number*
Alternate number
Spouse E-mail
example@example.com
Preferred form of contact*

Primary numberAlternate numberE-mailText
Spouse Birthday*

MonthDayYear
Can we publish this Birthday as we celebrate you? -- We will only publish the month and day.*

YesNo
Have you accepted Jesus Christ into your life as your personal Lord and Savior?*

YesNo

About the Kiddos

Skip this section, if not applicable.
Children: Enter name, birthdate and grade level.
example: Mark Marvel, 4/11/1999, 5th grade, Mary, 2/12/2002, 2nd grade

By submitting this completed form you are confirming that you have or will complete the necessary covenant classes.*

What We BelieveDiscipleship/MembershipBiblical OrdinancesDiscover Your Spiritual Gifts I & II
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The Power Center, International