Empowerment Life Church
Membership Form
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Spouse name (If applicable)
Wedding Anniversary (if applicable)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Names and ages of children (If applicable)
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Are you baptized ?
Please Select
YES
NO
Are you saved?
Please Select
YES
NO
Do you have any ministerial Interests, talents, or volunteering interests? if so please explain
What other areas of ministry have you worked in before? (if applicable)
Do you have any special needs or accommodations ?
Tshirt size?
Empowerment Life Church reserves the right to use photography and or videos for marketing purposes including online and social media. Empowerment Life Church retains all rights, title and interest in these materials and may use and disseminate them in a variety of ways, in its sole judgement. This permission is not inclusive of third-party vendors contracted for Empowerment Life Church:
I give consent to Empowerment Life Church to take photographs of me and [my child(ren)] and use these materials as described above.
I do not give consent Empowerment Life Church to take photographs of me and [my child(ren)] and use these materials as described above.
Submit
Should be Empty: