New Disciples Online Form
Please fill in completely and submit. Once received someone from the New Disciples Ministry will be in contact with you.
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Title
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Choose
Mr.
Mrs.
Ms.
Complete Name (First, Middle, Last)
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Your answer
Home Address
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Your answer
City, State, Zip
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
Marital Status
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Single
Married
Divorced
Home Phone No.
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Your answer
Cell Phone No.
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Your answer
Work Phone No.
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Your answer
Email Address
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Your answer
Occupation
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Your answer
Employer
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Your answer
Education Level
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Choose
High School
Some College
College Graduate
Professional Licenses/Certificates
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Your answer
Emergency Contact Name, Relationship and Phone No.
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Your answer
Have you been baptized?
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Yes
No
How did you join?
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New Convert
Reinstated
Watch Care
Christian Experience
N/A
Do you have any relatives that are members of Mount Aery? If so please list their names and relationships
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Your answer
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