Membership Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Year: 2025 - 2026

Today's Date *

YYYY

Name *

Street Address *

City State Zip *

Phone

Email Address

Date of Birth (month / day only) for each family member

May we contact you by email?

Yes

Clear selection

Would you like to be included in our Church Directory?

Yes

Clear selection

Would you like to subscribe to the Church Newsletter? (email address required)

Yes

Clear selection

We need volunteers!! Where can you help?

Events

Healing

Kitchen

Social Media

Technology Team

Ushering

Other:

Membership Drive Raffle

for a 30-minute reading with one of our Certified Mediums.

Donate an additional $25

Please visit our website for event listings.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report