Bethany Baptist Church New Membership Form
2587 Campostella Road, Chesapeake, VA 23324
Personal Information
First Name
Last Name
Gender
Male
Female
Marital Status
Single
Married
Divorced
Widowed
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Method of Contact
Phone
Text
Email
Spiritual Journey
Have you accepted Jesus Christ as your Lord and Savior?
Yes
No
Date of Salvation (If known)
-
Month
-
Day
Year
Date
Have you been Baptized?
Yes
No
Date and Place of Baptism
Previous Church Affiliation
Reason for Leaving Previous Church
Membership Type
Choose all that are applicable
Candidate for Baptism
Christian Experience
Watch Care
Rededication
Transfer of Membership
Family Information
Spouse's Name
First Name
Last Name
Names and Ages of Children
Ministry Interests
Please list any areas of interest or gifts you'd like to use in ministry
Signature
Date
-
Month
-
Day
Year
Date
Take Photo
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