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MEMBERSHIP
REQUEST
*
Indicates required field
Head of house name
*
First
Last
Head of house email
*
Phone Number
*
i.e. 000/000/0000
Date of Birth
*
i.e. MM/DD/YYYY
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Does head of household ask for membership?
*
Yes
No
Does Spouse ask for membership?
*
Yes
No
SPOUSE INFORMATION
Spouse Name
*
First
Last
Spouse date of birth
*
i.e. MM/DD/YYYY
Spouse Email
*
Spouse phone Number
*
Wedding Anniversary Date
*
N/A if not applicable
Are you a Christian?
*
Yes - Head of household
Yes - Spouse
Yes - Children over age 6/yrs
No - Children under age 6/yrs
No - Would like to know more
Are you a Veteran?
*
Head of household
Spouse only
Both
Neither
Have you been baptized?
*
Yes - Head of household
Yes - Spouse
Neither
FAMILY INFORMATION
Child #1 Name
*
First
Last
Child #3 Name
*
First
Last
Child #2 Name
*
First
Last
Child #4 Name
*
First
Last
If additional Children please add them in the "anything else" area below.
Are Children asking for membership?
*
Yes
No
DO KIDS DESIRE baptism?
*
Yes - Child over 6/yrs
No - Child under 6/yrs
No - Not at this time
Photo Permission
*
Yes - Whole Family
No - Whole Family
Yes - Kids Only
No - Kids Only
Do we have permission to use your images in photos for promotion of the church?
Is there anything else you would like for us to know?
*
I agree to receiving marketing and promotional materials
*
Submit Membership Request
Home
Start Here
Our beliefs
Church Covenant
Church Membership
Baptism
Child Dedication
Meet Us
Next Steps
Steps To Peace
Volunteer Ministries
Discover Your Gifts
Ministries
Ministry Groups
Kids
Students
>
SummerSalt
Missions
Prayer
Life Groups
Kids
>
The Garden
The Depot
Crossroads
Sermons
Events
Event Promos
Medical Release
VBS
Blog
Give
Contact Us