Brookdale Christian Center AG
6030 Xerxes Ave N Brooklyn Center, MN 55430 brookdalechristiancenter@gmail.com - www.bccag.com
Church Membership Questionnaire
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How old are you?
18-25
26-35
36-45
46-55
56-65
Other
How did you hear about us?
A Church Member
A Friend
A Family Member
A Cast or Crew Member
Other
How would you describe your walk with Jesus Christ?
I'm looking for a church home
I have a church home, but I'm not saved
I have a church home and I am saved
I am spiritual, but I don't go to church
I prefer not to answer
Are you active on social media? (ie: Facebook, Twitter, or Instagram)
Yes
No
If so, what is your handle?
If we were to sell merchandise in the future, what items would you be most interested in? Check all boxes that apply.
T-Shirts
Mugs
Bible Covers
Calendars
Keychains
Phone Covers
Planners
Canvas Bags
Submit
Should be Empty: