Port City Church
Membership Application
Full Name
Your answer
Maiden Name or Alias
Your answer
Complete Address *
Your answer
Your Birthday *
MM
/
DD
Date and place of last church attended *
Your answer
Date Converted *
MM
/
DD
/
YYYY
Date Baptized in the Holy Spirit
Your answer
Date baptized in water
MM
/
DD
/
YYYY
Marital Status *
Name of Spouse
Your answer
Anniversary
MM
/
DD
Is your spouse a born again Christian?
Dependent Children
Please give full name and birthday (month/day)
Your answer
Comments
Your answer
*All potential members must have attended WFA 3 months prior to membership.
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