POGCH Member Intake Form

PILLAR OF GRACE CHURCH - HOUSTON

MEMBERSHIP INTAKE FORM
Member ID
(for Church Purposes)
The Purpose of membership at the Pillar of Grace Church is to provide a way for the believer in the Lord Jesus Christ to express a definite commitment to this local body of Christ.
Date

MonthDayYear
Date
Email
example@example.com
Please Select One:

Mr.Mrs.MissDr.Rev.Other
Last*
First*
Middle
Birthdate*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Work Phone
Cell Phone
Martial Status

SingleMarriedDivorcedWidowed
Marriage Anniversary Date

MonthDayYear
Date
Occuptation
Maiden Name
Number of Children
Name of children in your family living at home
Birth Date of Child 1

MonthDayYear
Date
Name of children in your family living at home
Birth Date of Child 2

MonthDayYear
Date
Name of children in your family living at home
Birth Date of Child 3

MonthDayYear
Date
Name and address of Church where you were attending:
Name of Church
Pastor's Name
Address of Church You were Attending?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Old Church Phone Number
Please enter a valid phone number.
Have you accepted Christ as your personal Savior?

YesNo
Date you Accepted Christ

MonthDayYear
Date
Do you need to be baptized?

YesNo
Campus Member
Virtual EMember
Where would you like to work in the Church? Check all that apply.

Pastor AppreciationPOGCH Youth/Children MinistryPOGCH Mens MinistryPOGCH Womens MinistryFirst Lady AideOutreach MinistrySingles MinistryMarried Couples Ministry
Should be Empty:

PILLAR OF GRACE CHURCH - HOUSTON