APPLICATION FOR CHURCH MEMBERSHIP
Name
First and Middle Name
Middle Name
Last Name
Suffix
Gender
Male
Female
Marital Status
Single
Married
Divorced
Widowed
Date of Birth
-
Month
-
Day
Year
Date
Anniversary Date
-
Month
-
Day
Year
Date
Name of Parent/Guardian If Under Age 18
First Name
Last Name
Spouse's Name (If Married)
First Name
Last Name
Dependent Children's Names (If Applicable)
First Name
Last Name
First Name
Last Name
First Name
Last Name
First Name
Last Name
Home Phone Number
Please enter a valid phone number.
Mobile Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you currently a member of another local church?
Yes
No
If Yes, name of other church
Name of Pastor
Phone Number
Please enter a valid phone number.
Are you relocating from another area?
Yes
No
Were you a member of a church there?
Yes
No
If Yes, name of other church
Name of Pastor
Phone Number
Please enter a valid phone number.
Have you accepted Jesus Christ as your Savior?
Yes
No
If yes, when?
Have you been baptized in water?
Yes
No
If yes, when?
Will you support Regional Church with your: prayers, attendance, ministry gifts, and financial support?
Yes
No
Would you like to share with us a short testimony of your salvation? (optional)
Other comments, if any:
Thank you for taking the time to fill out this Application for Church Membership form. Church membership is vital to your spiritual growth. My desire is that we grow together in love, maturity, and Christlikeness. Let’s commit ourselves to each other. Together we are stronger. Together we reflect Christ’s image more fully. Together, we can make Jesus Famous to the World! Blessings to you, Pastor Mitchell Bias
Signature
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