ACAG Membership
MEMBERSHIP APPLICATION
PLEASE TELL US ABOUT YOURSELF
Please provide all required information
Legal Name
*
First Name
Middle Initial
Last Name
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
ACAG Bylaws require members to be at least 18 years of age. Are you at least 18 years old?
*
Yes
No
E-mail
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Mobile Number
*
Please enter a valid phone number.
Place of Employment (if any)
Marital Status
*
Please Select
Married
Single
Divorced
Spouse's Name (if Married)
Will You Attend Together?
Yes
No
Not Sure
PLEASE TELL US ABOUT YOUR FAMILY
PLEASE LIST ANY OTHER IMMEDIATE FAMILY MEMBERS
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Relationship
Please Select
Son
Daughter
Grandson
Granddaughter
Niece
Nephew
Other Relation
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Relationship
Please Select
Son
Daughter
Grandson
Granddaughter
Niece
Nephew
Other Relation
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Relationship
Please Select
Son
Daughter
Grandson
Granddaughter
Niece
Nephew
Other Relation
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Relationship
Please Select
Son
Daughter
Grandson
Granddaughter
Niece
Nephew
Other Relation
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Relationship
Please Select
Son
Daughter
Grandson
Granddaughter
Niece
Nephew
Other Relation
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Relationship
Please Select
Son
Daughter
Grandson
Granddaughter
Niece
Nephew
Other Relation
PLEASE TELL US ABOUT YOUR FAITH
Provide a short response to each question, we will explore these questions further during the membership application process.
How long have you been attending Alma Center Assembly of God?
*
Please Select
Less than 6 months
6 mos. to 1 year
Over 1 year
Briefly Describe Your Relationship With Jesus Christ
*
Briefly Describe the Reasons you would like to be a Member of ACAG?
*
List Any Training, Education or Spiritual Gifts That Have Shaped Your Walk with Christ
ONE LAST THING
This question is required to provide protection for all attendees of Alma Center Assembly.
Have You Ever Been Accused, Charged With, or Alleged to Have Committed Any Act of Neglect, Abuse, or Molestation against a Minor?
*
No
Yes
I understand that submitting this application for membership is the first step of the Board approved process and I intend to follow all requirements including but not limited to an interview with the pastor or designated representative of the church, attending a membership class, and agreement with the tenets of faith held by ACAG. I understand that Membership will require final review and approval by the Board of Directors.
*
I Agree
I Disagree
Send
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