MEMBERSHIP INFORMATION

PLEASANT HILL BAPTIST CHURCH

Pastor Reginald G. Reid, Sr.
MEMBERSHIP CONTACT INFORMATION
Name
Adult Number One
Name
Adult Number Two
Phone Number (Home)
(Area Code/Phone Number)
Phone Number (Home)
(Area Code/Phone Number)
Phone Number (Cell)
(Area Code/Phone Number)
Phone Number (Cell)
(Area Code/Phone Number)
Street Address*
Apt. No.
City/State*
Zip Code*
List all family members under age seventeen (17) that are PHBC members.
Child (1)
Phone Number
(Area Code/Phone Number)
Child (2)
Phone Number
(Area Code/Phone Number)
Child (3)
Phone Number
(Area Code/Phone Number)
Child (4)
Phone Number
(Area Code/Phone Number)
Child (5)
Phone Number
(Area Code/Phone Number)
Child (6)
Phone Number
(Area Code/Phone Number)
Should be Empty: