Membership Application

Date
Date Format: MM slash DD slash YYYY
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Personal Data
Date of Birth
Date Format: MM slash DD slash YYYY
Marital Status
Date of Anniversary
Date Format: MM slash DD slash YYYY
Children (first, middle, and last names) and DOBs
Place of Employment
Position

When were you born again?*
Date Format: MM slash DD slash YYYY
Briefly describe the circumstances. Where, how, who was instrumental?*
Have you been baptized by water?
- No
- Yes
If so, when?
What was the method?
- Immersion
- Sprinkling
- Pouring
- Infant
Why did you get baptized?
List the churches you have attended or were a member of, and what years you attended.
If you're coming from another church, briefly list your reasons for leaving:
May we contact your previous pastor?
- Yes
- No

Are you now or have you ever been dependent on drugs or alcohol?*
- Yes
- No
Are you now or have you ever been under the care of a counseling professional?*
- Yes
- No
- I'd rather talk in person
Have you ever had a criminal record for anything other than a traffic violation?*
- Yes
- No

Do you acknowledge that you have read the Church Discipline Policy, that you understand the church discipline policies of this church and that you agree to follow the policies and procedures set forth there?
- Yes
- No
Do you affirm by "checking the box" below that should you ever have a dispute with the church that cannot be resolved through its own internal procedures, you agree to resolve the dispute according to biblical principles (such as set forth in Matthew 5:23-25 and 18:15-20, and 1 Corinthians 6:1-8) by submitting the matter to Christian mediation and, if necessary, arbitration, according to the policies of this church?
- Yes
- No
Electronic Signature
By signing below, I acknowledge that I am the individual named on the application and that the information provided is true and correct. I also agree to be legally bound by this electronic signature.
Name
First Last
Signature
Date
Date Format: MM slash DD slash YYYY

Personal Data