GTC Member Data Form

GREATER TABERNACLE CATHEDRAL CHURCH OF GOD IN CHRIST MEMBERSHIP DATA SHEET

11300 South Dr. Martin Luther King, Jr. Drive | Chicago, Illinois 60628
PERSONAL
Date

MonthDayYear
Date
First Name
Middle
Last
Street Address
City
State
Zip
Phone Number
Email Address
example@example.com
Cell
Age
Date of Birth

MonthDayYear
Date
Marital Status

MarriedSingleDivorcedWidowed
Employer

If you have a child or children under the age of 21, please complete the section below:

List your previous church roles / responsibilities

GENERAL
Special Training/Skills
Describe your health condition

ExcellentAveragePoor
Do you have any physical limitations? If yes, please explain:

NoYes
Describe your physical limitations
Please give a brief statement of your testimony
Please list two persons that can be contacted in case of emergency:
Name
Address
Phone
Relationship
Name
Address
Phone
Relationship
"Verily, verily, I say unto you, he that believeth on me, the works that I do shall he do also; and greater works than these shall he do; because I go unto my Father." John 14:12
Should be Empty:

GREATER TABERNACLE CATHEDRAL CHURCH OF GOD IN CHRIST MEMBERSHIP DATA SHEET