Membership Registration Form

New Member Registration

Complete the form below to sign up for our membership.
Name*

First NameLast Name
E-mail*
Phone Number:*

Area CodePhone Number
Preferred way to contact Phone Email Any*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date:*

MonthDayYear
Why Would You Want To Join Tears To Purpose?*
What Are You Looking To Gain From Being Apart Of The Ministry?*
Do You Believe In Jesus Christ?*
Are You Willing To Pay $20 Dollar Membership Fee? **
Are You Ready To Tell Your Testimony? *
You consent to receive communications from us electronically. We will communicate with you by e-mail or phone. You agree that all agreements, notices, disclosures and other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing.
Signature

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Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!
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New Member Registration