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Membership Form
Name *
Last name *
What is your marital status?
Single
Married
Divorced
Widowed
E-mail *
Address *
Address *
Address line 2
City *
State / Region
Postal / Zip Code *
Country *
United States of America
Phone *
Date of birth *
What do you do for a living? *
Since when have you visited us? *
How did you find out about the church? *
Have you been born again, according to John 3:3-7?
Have you accepted the Lord Jesus Christ as your only Savior?
Yes
No
I want to ( if so, please use the contact information to contact us)
Have you been baptized in water?
Yes
No
Yes, but I would like to do it again?
Have you taken Basic Doctrine?
Yes
No
In case of an emergency, who may we contact ? *
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