EmailMeForm
New Disciple's Registration
Select Membership Category
*
Candidacy for Baptism
Christian Experience
Watch Care
Re-instated
Transfer
Name
*
First
Middle
Last
Suffix
Date of Birth
MM
/
DD
/
YYYY
Gender
*
Male
Female
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Email
*
Preferred Phone Number
*
###
-
###
-
####
Phone number type:
*
Mobile Phone
Landline
Is someone joining the church with you?
*
Yes
No
Please identify relationship of family members joining with you?
*
Spouse
Child(ren)
Other Family Member
Spouse's Name
*
First
Middle
Last
Suffix
Spouse's Date of Birth
*
MM
/
DD
/
YYYY
Spouse's Email
*
Additional Family Member Information
First Name
Middle
Last Name
DOB (MM/DD/YYYY)
Gender
Relationship (child, etc.)
1
2
3
4
5
6
In Care of Deacon:
Envelope/ID # Primary
Envelope/ID # Spouse
Envelope/ID # Spouse
Envelope/ID # Other
