PENTECOSTAL CHURCH OF JESUS CHRIST, M.I., INC
CHURCH MEMBERSHIP APPLICATION
YOUR INFORMATION
Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
*
Male
Female
Marital Status
*
Single
Married
Widowed
Divorced
If married, date of marriage:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Salvation
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of Water Baptism
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Affiliation Date/Starting Date?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
My previous church association was:
List any ministry experiences:
Education:
Current Profession:
SPOUSAL INFORMATION
Name
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Male
Female
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Salvation
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of Water Baptism
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
When did you start attending PCJC?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
My previous church association was:
List any ministry experiences:
Education:
Current Profession:
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Owner?
Yes
No
Business Owned (if applicable):
CHILDREN (Please fill out the sections for EACH child)
Rows
First Name
Last Name
Date of Birth
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Add any additional information about your family
Submit
Should be Empty: