PIA Membership Application

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SPECIAL NOTE FOR VIRTUAL MEMBERS:

Connecting through Virtual Membership allows you to get the same privileges as regular membership of PIA.

Virtual Meet and Greet with our Pastors (Zoom link will, be provided for those who apply)

Access to Virtual Services, Newsletters, Emails, and Events

PIA Meetings TBA

Quarterly Virtual Connection

1st Quarter (Get a chance to meet each other and participate in challenges and activities)

2nd Quarter (Different Group Meetings) dates and times TBA

3rd Quarter: Psychoeducational Groups
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Type of Membership:* This field is required.
Regular Membership (I live near Buford, GA)
Virtual Membership (I do not live near Buford, GA)
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Full Name:* This field is required.
First Name
Last Name
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Other Names you may go by:
First Name
Last Name
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Mailing Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Is your mailing address the same as your physical residence?* This field is required.
YES
NO
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Physical Address:* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Birth Date:* This field is required.
Month
Day
Year
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Home Phone Number:* This field is required.
Area Code
Phone Number
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Cell Phone Number:* This field is required.
Area Code
Phone Number
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E-mail Address:* This field is required.
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code?or
Receiving the email may take a few minutes, thank you for your patience!
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Sex:* This field is required.
Male
Female
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Nationality* This field is required.
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Are you currently employed?* This field is required.
YESNO
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Occupation:* This field is required.
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Place of Employment:* This field is required.
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Position Title at Employer:* This field is required.
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Work Number* This field is required.
Area Code
Phone Number
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Marital Status:* This field is required.
Married
Separated
Widowed
Single
Engaged
Divorced
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Date of Anniversary* This field is required.
Month
Day
Year
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Is your spouse applying for membership with you?* This field is required.
YESNO
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Spouse Name:* This field is required.
First Name
Last Name
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Other Names Spouse may go by:
First Name
Last Name
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Spouse Cell Phone Number:* This field is required.
Area Code
Phone Number
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Spouse Email Address:* This field is required.
example@example.com
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Spouse Sex:* This field is required.
Male
Female
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Nationality:* This field is required.
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Does your Spouse work?* This field is required.
YESNO
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Spouse Date of Birth:* This field is required.
Date
Year
Month
Day
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Spouse Occupation:* This field is required.
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Spouse Place of Employment:* This field is required.
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Spouse Position at Employer:* This field is required.
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Work Phone Number:* This field is required.
Area Code
Phone Number
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Do you have kids?* This field is required.
YESNO
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List Children’s Names (only list those under 18 years who will be included in your membership and provide their passport sized)* This field is required.
NAME, GENDER, AGE, BIRTHDAY
NAME, GENDER, AGE, BIRTHDAY
NAME, GENDER, AGE, BIRTHDAY
NAME, GENDER, AGE, BIRTHDAY
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CHILD 1 PHOTO
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Select files to upload
Max. file size: 10.6MB
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CHILD 2 PHOTO
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Select files to upload
Max. file size: 10.6MB
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CHILD 3 PHOTO
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Select files to upload
Max. file size: 10.6MB
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CHILD 4 PHOTO
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Have all those in your family who are seeking membership received Christ? If not, to your knowledge, who has not yet received Christ?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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Have you participated in another religion?
YESNO
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If so, what religion have you been a part of?* This field is required.
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Check all who have been baptized in water by immersion:* This field is required.
Self
Children
Spouse
None of us
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Check all who have received the baptism in the Holy Spirit by faith with the evidence of speaking in other tongues:* This field is required.
Self
Children
Spouse
None of us
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Why do you feel that you want to enter into a “family” relationship with this church body?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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Does any member of your family require psychological, behavioral, or intellectual assistance and services?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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Do you share and embrace in PIA mission of “Energizing the World with Biblical Truth, while creating Movements of Change?”* This field is required.
YESNO
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What gifts, talents, and abilities do you feel you (and/or your family members) are willing to contribute to PIA?* This field is required.
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Large
Normal
Small
Ok
Ok
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Which ministries are you (and/or your family members) interested in?* This field is required.
Men's Ministry
Youth Ministry
Women's Ministry
Teens/Young Adults Ministry
Singles Ministry
Marriage Ministry
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