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PERMOHONAN MENJADI WARGA
Bersama ini kami sekeluarga mohon menjadi warga Gereja Kristen Jawa Eben-Haezer, Pasar Minggu, Jakarta Selatan
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Nomor Induk Gereja (Diisi kantor gereja)
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Nama
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Alamat Lengkap
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Telepon/HP
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Hubungan Keluarga (Bapak/Ibu/Anak/Lainnya)
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Tempat lahir
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Tanggal lahir
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Tempat Baptis
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Tanggal Baptis
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Tempat Sidi
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Tanggal Sidi
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Tempat Nikah
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Tanggal Nikah
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Gereja Asal
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Alamat Gereja Asal
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