Membership Form
Date
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Month
-
Day
Year
Date
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
*
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Email:
*
example@example.com
Date of birth
*
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Month
-
Day
Year
Occupation:
Marital Status
*
Married
Single
Divorced
Widowed
Separated
Wedding Anniversay
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Month
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Day
Year
Skills, talents, and hobbies:
Please provide the name of an Emergency Contact:
*
Phone Number
Please enter a valid phone number.
Relationship:
Please provide the following information about your child #1
Child's Full Name
Date of birth
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Month
-
Day
Year
Grade:
Please provide the following information about your child #2
Child's Full Name
Date of birth
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Month
-
Day
Year
Grade:
Please provide the following information about your child #3
Child's Full Name
Date of birth
-
Month
-
Day
Year
Grade:
Please provide the following information about your child #4
Child's Full Name
Date of birth
-
Month
-
Day
Year
Grade:
What are your areas of interest in the ministry?
*
Prayer Ministry
Outreach/Evangelism Ministry
Singles Ministry
Youth Ministry
Marriage Ministry
Young Adults Ministry
Men's Ministry
Praise & Worship Ministry
Women's Ministry
Media Ministry
Hospitality/Ambassador Ministry
My confession today is that:
Today, I have accepted Jesus Christ as my Lord and Savior and I believe that he has called me to be a part of this ministry.
I am already a born again believer and I believe that the Holy Spirit has called me to be a part of this ministry.
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Please answer the following questions below so that we may know how to assist you.
Have you been baptized?
*
Yes
No
Would you like to be baptized?
*
Yes
No
Have received the Baptism of the Holy Spirit that is evidenced by speaking in tongues?
*
Yes
No
Your signature below indicates that you are joining Dominion World Outreach Ministries of your own free will and you have agreed with the Tenets of Faith and have been provided with a personal copy for your record.
*
SIGNATURE
Date
*
-
Month
-
Day
Year
Date
Please upload a picture of yourself for new membership graduation purposes.
*
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DOMINION WORLD OUTREACH MINISTRIES OFFICIAL SUBMISSION AND RELEASE FORM
Participant's Name
*
First Name
Last Name
Parent/Guardian (if under 18)
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please read the following below:
I, undersigned, without reservation or condition or anticipation of financial remuneration, give my permission to Dominion World Outreach Ministries to use photographs, videotapes, or stories of me or my minor child/children during any services, programs, activities or workshops. I hereby irrevocably authorize Dominion World Outreach Ministries, to edit, alter, copy, exhibit, publish or distribute photos and/or accompanying stories for the purposes of publicizing Dominion World Outreach Ministries programs or for any other lawful purpose. In addition, I waive the right to inspect, or approve of the finished product, including written or electronic, wherein my work appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph, videotape or story. I understand and agree that these materials will become the property of Dominion World Outreach Ministries and will not be returned. I hereby hold harmless and release and forever discharge Dominion World Outreach Ministries from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf of my estate have or may have by reason of this authorization.
Participant Signature
*
Date
*
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Year
Date
Parent/Guardian Signature
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Date
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