Name *

First Name

Last Name

Date of Birth *

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DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Baptism Date

Baptism Date if known

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DD

YYYY

Membership Type *

Full Member

Associate Member

Ministry Interests

Any areas of ministry you are interested in serving?

Life Group Leading

Praise Team

A/V

Children's Ministry

College Ministry

Administration

Finance Committee

Member Care

Other