Name of Person Registering-Head of household *
Name of Person Registering-Head of household
Phone of Head of household *
Phone of Head of household
Type of phone *
Birthday of Head of household *
Birthday of Head of household
Name of Spouse *
Name of Spouse
please write in NA if no spouse
Phone of Spouse *
Phone of Spouse
if no spouse enter 803.547.7781
Type of phone *
Birthday of Spouse *
Birthday of Spouse
if no spouse enter 01-01-2019
Wedding Anniversary *
Wedding Anniversary
if not married enter 01-01-2019
Are you a veteran? *
Are you a Christian? *
Have you been baptized? *
Do you wish to be baptized? *
Tithe envelopes? *
Do you wish to receive envelopes for tithing?
Please list kids who are living at home. List date of birth including year. If no kids, enter NA.
Do kids desire baptism? *
Are kids asking for membership? *
Kids older than 6 are eligible for membership. Please choose no if NA.