Membership Information
Please complete the information
Email *
I BELONG HERE!
Date
 *
MM
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DD
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YYYY
Name (First and Last)
 *
DOB *
MM
/
DD
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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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