The Park Church Membership Information Form
Please complete information below
Today's Date
-
Month
-
Day
Year
Date
Campus attended
Beatties Ford Road
Independence
South Charlotte
Online
Name
Please include full name
Gender
Male
Female
Please select one
Marital Status
Married
Single
Divorced
Widowed
Separated
Please select one
Date of Birth
-
Month
-
Day
Year
Date
Street address
Street address line 2
City
State
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
E-mail address
Occupation
Phone Number
-
Area Code
Phone Number
Are you related to a member of The Park?
YES
NO
If yes; member's name and relationship.
Are you a current college student?
YES
NO
If yes, What college do you attend?
Emergency contact Name/ Number
I desire membership by:
Baptism
Christian Experience/ Letter
Watch-care
Restoration
Please select only ONE option
I want to baptized into the Christian faith by water immersion
I was a member of another Christian church and I have accepted Jesus Christ as my personal Savior and/or letter will be sent from my previous church.
I am in Charlotte temporarily for work or school; and am currently a member of another church.
I am a former member of this church and I would like to be restored back into membership.
Other
If in Charlotte temporarily, name and location of current church.
If a former member, last time attending this church.
-
Month
-
Day
Year
Last date attended
Submit
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