Member Information

Contact Information.

Full Name *

Preferred Name

Baptized? *

Yes

No

Street Address *

City *

State *

Zip Code *

Email Address *

Phone Number

Mobile Phone Number *

Which number is best to contact you? *

Home

Mobile

Gender *

Male

Female

Date of Birth *

Marital Status *

S

M

D

W

Select Your Campus *

Main Campus

Online Campus

If married, Anniversary Date (Please include year for both DoB and Anniversary). *

Spouse's Name

Will Spouse be joining? Y/N (if Y complete form for each spouse) *

Y

N

Occupation

Employer (Use N/A if not employed). *

Minor Children Living At Home.

Full Name

Baptized?

Yes

No

Birthday

Full Name

Baptized?

Yes

No

Birthday

Full Name

Baptized?

Yes

No

Birthday

Full Name

Baptized?

Yes

No

Birthday

Full Name

Baptized?

Yes

No

Birthday

Full Name

Baptized?

Yes

No

Birthday

Full Name

Baptized?

Yes

No

Birthday

Full Name

Baptized?

Yes

No

Birthday

Full Name

Baptized?

Yes

No

Birthday

Church Experience.

Former Church

Street Address

City

State

Zip Code

Senior Pastor's Name

Are you currently an active member?

Yes

No

For Salvation and Baptism Records

Salvation.

Pray for salvation in accordance with the scripture found in Romans 10:9, "v If you declare with your mouth, “Jesus is Lord,” and believe in your heart that God raised him from the dead, you will be saved."

The Sinner's Prayer is an evangelical Christian term referring to any prayer of repentance, prayed by individuals who feel convicted of the presence of sin in their lives and have the desire to form or renew a personal relationship with God through Jesus Christ.

Prayer of Salvation

"Father, I know that I have broken your laws and my sins have separated me from you. I am truly sorry, and now I want to turn away from my past sinful life toward you. Please forgive me, and help me avoid sinning again. I believe that your son, Jesus Christ died for my sins, was resurrected from the dead, is alive, and hears my prayer. I invite Jesus to become the Lord of my life, to rule and reign in my heart from this day forward. Please send your Holy Spirit to help me obey You, and to do Your will for the rest of my life. In Jesus' name, I pray, Amen Always."

Date you confessed Jesus Christ as Lord (Romans 10:9): *

Water Baptism.

Those who are baptized are following Jesus’ example and obeying His command.

Baptism is an outward sign of an inward change. It is a public declaration that you are

1) a follower of Jesus Christ,

2) beginning a changed life, and

3) you are part of a new family.

Date baptized:

If never baptized then, do you want to be baptized? *

Yes

No

Join the "A" Team

Please indicate any interest in these ministry areas and somebody will follow up with you. *

Other areas you may desire to serve:

Other information you want to share about yourself (hobbies, interests, etc.)

Are there any special needs/health issues we should be aware of?:

Dietary restrictions (ie: Gluten Free Communion)?:

Optional

Your Photo.

Family Photo.

Child(ren) Photo.

Signature *

clear

Elder	Deacon	Trustee	Greeter
Usher	Choir/Singing	Worship Leader	Admin Support
Adult	Youth	Elementary	Preschool
Nursery	Junior Church	Youth Group	Parking Lot Attendant
Missions	Christian Education	Youth Protection	Finance
Outreach	Prayer Team	Women's Group	Bible College