Membership Form
What service did you join?
*
Please Select
8:00 AM Sunday Worship Experience
10:00 AM Sunday Worship Experience
12:00 PM Sunday Worship Experience
Not in Person- Online Submission
NYE Service
Head of Household Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
*
Please enter a valid phone number.
Home Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Gender
*
Please Select
Female
Male
Martial Status
*
Please Select
Single
Married
Divorced
Widowed
Do you have dependent children age 17 or younger joining at this time?
*
Please Select
Yes
No
Are you currently enrolled in a college/university?
*
Please Select
Yes
No
Please list the name of your college/university.
Are you in or have previously served in the military?
*
Please Select
Yes
No
Military Branch
Please Select
Air Force
Army
Marines
Navy
National Guard
Reserve
Retired
Employer
*
Occupation
*
Spouse Information (if Married)
Spouse Name
First Name
Last Name
Are they joining at this time?
Please Select
Yes
No
Already a member
Date of Birth
-
Month
-
Day
Year
Date
Cell Phone Number
Please enter a valid phone number.
Email
example@example.com
Gender
Please Select
Female
Male
Are you in or have previously served in the military?
Please Select
Yes
No
Military Branch
Please Select
Air Force
Army
Marines
Navy
National Guard
Reserve
Retired
Employer
*
Occupation
*
Wedding Anniversary
-
Month
-
Day
Year
Date
Children
Dependent children 18 years of age and above and are also joining must complete a separate form even if they reside in same household as parent/guardian.
Name of Child
First Name
Last Name
Are they joining at this time?
Please Select
Yes
No
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Female
Male
Name of Child 2
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Are they joining at this time?
Please Select
Yes
No
Gender
Please Select
Female
Male
Name of Child 3
First Name
Last Name
Are they joining at this time?
Please Select
Yes
No
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Female
Male
Name of Child 4
First Name
Last Name
Are they joining at this time?
Please Select
Yes
No
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Female
Male
Name of Child 5
First Name
Last Name
Are they joining at this time?
Please Select
Yes
No
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Female
Male
Known Allergies
Please list any known allergies for any family listed on form that will be joining at this time (i.e. David-peanuts). If there are none, please enter N/A.
Individual's Name and Allergy
*
Emergency Contact
Preferably someone that is not already listed in household.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Church History
Previous Church
Contribution Information
For tax filing purposes:
Please Select
Individual
Joint
Submit
Should be Empty: