Membership and ID Card Request Form

Membership and ID Card Request Form
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
We kindly ask, who referred you?
Photo Requirements:

The Photo:
- clear and in focus
- in colour
- unaltered by computer software
The digital photo:
- must have been taken in the last month or new
- contain no other objects or people
- be taken against a plain light-coloured background
- be in clear contrast to the background
You in the photo:
- must be facing forwards and looking straight at the camera
- have a plain expression and your mouth closed
- have your eyes open and visible
- must not have hair in front of your eyes
- must not have a head covering (unless it’s for religious or medical reasons)
- must not have anything covering your face
- must not have any shadows on your face or behind you
- must not wear sunglasses or tinted glasses. You can wear other glasses if you need to, but your eyes must be visible without any glare or reflection.
Upload Your Headshot Here: *
Or Take a Live Photo Here:
Reason(s) for ID Card*

New Member CardLostNew TitleDamaged CardN/A (Not applicable, paying for member sign up only)Other
Role*

MemberFacilitatorElderFounder
Delivery*

Post to AddressCollection on siteOther
Notes/Comments
Signature*
Member Contributions:

Membership Donation is a required one time fee for initially joining the church. Optional ID Card fee is listed below. Additional donations are accepted at any time. If your payment transaction fails or incurs any technical issues, please Zelle your balance to andylarson99@hotmail.com .
My Products
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Membership Donation
One time required membership fee.

$108.00 Quantity



Membership Photo ID Card
One time fee for your personalized ID card.

$75.00 Quantity



Additional Donations
Optional Charitable Contribution.

$100.00 Quantity



Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Membership and ID Card Request Form

Member Contributions: