Church Membership Form

Kingdom Life Temple of Deliverance Church Membership Form

389 Dover Chester Road, Randolph, NJ | Founder: Bishop J. Samuel Canion
Name*

PrefixFirst NameMiddle NameLast NameSuffix
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
What is your current marital status?*

SingleMarriedSeparatedDivorcedWidowed
Type of church membership you are seeking*

Onsite - Randolph, NJOnline - eChurch Member
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please include the names, ages, and birthdates of your spouse and children if applicable
Are there any medical conditions that we should be aware of in case of an emergency?*
Were you recently a member of another church?*

YesNo
What are some of your professional abilities and talents?*
What spiritual gifts or offices do you believe God has called you to operate in?*
What role(s) do you see yourself working in at Kingdom Life Temple of Deliverance?*

Greeters TeamPraise & Worship TeamChristian Education TeachersHospitality TeamSight & Sound Team - AV/Social Media/Flyers/WebsiteExecutive Staff to the Bishop & 1st LadyAdjutancy Corp
Are you a born again Christian?*

YesNo
Have you been water baptized in the name of Jesus?*

YesNo
Have you been filled with the precious gift of the Holy Ghost with the evidence of speaking in an unknown tongue as the Spirit gives utterance?*

YesNo
Could you share with us a short testimony of your relationship and walk with God in your life?*
Signature*

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Kingdom Life Temple of Deliverance Church Membership Form