Membership

Member Information

First Name (required)

Last Name (required)

"Goes by"name

Birthdate (required)

Contact Information

Email (required)

Phone Number (required)

Address (required)

Address Line 2

City (required)

State (required)
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zipcode (requied)

Work Information

Employer

Type of Work

Family Information

Marital Status (required)
---MarriedSinglePartneredWidowedSeparatedDivorced

Partner name (if residing at same adress)

Number of Children (required)

Children's Name(s), Birthdate(s), Grade(s), School(s)

Prior Church Membership

Church Name

Church City and State

Date of Baptism (or approximate date)

Were you and elder or deacon?
ElderDeacon

Joining by:
---Affirmation of faithRe-affirmation of faithLetter of TransferTransferNA