2025 Membership Application

First Name *

Middle Initial

Last Name

Home Address

Address Line 1

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Your Email

Cell Phone *

Home Phone

Gender (Male or Female)

Age

Family size

Family Details *

• Married
• Single
• Widow

Spouse Name ( If you are Married)

First

Last

List Your Children

Child #1 Full Name

Age

Gender (M or F)

Child #2 Full Name

Age

Gender (M or F)

Child #3 Full Name

Age

Gender (M or F)

Child #4 Full Name

Age

Gender (M or F)

How long have you been attending our church?

• Less than a year
• 1-2 years
• 2-3 years
• More than 3 years

Most recent Church you were a member of?

In What capacity did you serve in your previous churchs?

In What Capacity do you feel called to serve here now?

• Deacons and Fellowship
• Youth Ministry
• Prayer Team
• Media and Technology
• Choir & Worship Team
• Outreach and Testimony
• Home Bible Study
• Not Sure – help me

When did you accept Jesus Christ as your savior?

When and where did you receive water baptism?

Applicant Signature

Clear Signature

Date / Time

For Pastor/Elder Use

Reviewed by

Date / Time (copy)

Elder/Pastor Signature

Clear Signature

Submit