Membership Information
Please complete the information
Email *
I BELONG HERE!
Date
*
MM
/
DD
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YYYY
Name (First and Last)
*
DOB *
MM
/
DD
/
YYYY
Spouse Name (if apply)
Spouse DOB (if apply)
MM
/
DD
/
YYYY
Wedding Anniversary Date (if apply)
MM
/
DD
/
YYYY
Address, City, State and Zip Code
*

Area Code and Phone number
*
Occupation *
Place of Employment
*
Phone
*
Child/ren living with you (List name, DOB, M/F and age)
*
What was your last Church affiliation, Pastor's Name and phone number
*
Baptized?
*
If no, do you or other family members desire to be baptized?
*
Short summary of your ministry calling (if known)
*
What area(s) of ministry do you desire to serve within IHPAM?
*
What are your skills/expertise?
*
Are you willing to tithe to this ministry?
*
IN CASE OF EMERGENCY (Please list name, relationship and phone number)
*
A copy of your responses will be emailed to the address you provided.
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