Church Membership Form

Friendship M B C, Inc. Membership Application

All information on this form is strictly confidential
Full Name *

Prefix First Name Last Name Suffix
Date of Birth *

Month Day Year
E-mail *
example@example.com
Home Phone Number *

Prefix Number
Mobile Phone Number

Prefix Number
Preferred method of communication
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Do you believe in Jesus? *

YES NO
Have you been baptized? *

YES NO
If "YES", what is the name and location of the church where you were baptized? *
Type N/A if this does not apply to you
If "NO", are you willing to be baptized? *

YES NO
Should be Empty:

Friendship M B C, Inc. Membership Application