Membership Registration Form

Membership Registration Form
Name of Delegate*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Church Information
Name of Church
Name of Pastor
Location of Church
Title Information
Title in Ministry*

BishopOverseerPastorDistrict ElderElderMinisterDeaconBrotherProphetessMissionary EvangelistMissionary / MotherSisterVisitor/Guest
Auxiliary Department

Missionary DepartmentYoung people's DepartmentUsher National BoardWomen's CouncilClergy WivesBrotherhood DepartmentDeacon BoardMusic DepartmentDelegateVisitor/Guest
Enter the message as it's shown*
Should be Empty:

Church Information