Membership Transfer Form
Please provide the following information. This information will assist us with what we need to send for the membership transfer letter to your church and to ensure we have the correct information for you (and your family) here at Crossroads.
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General Information for Individual Requesting Membership Transfer:
Full name:
Address:
Phone Number:
Email Address:
If You Are Requesting Membership Transfer For Yourself Plus Family Members:
Please complete applicable questions.
Full Name of Additional Adult:
Phone Number of Additional Adult:
Email Address of Additional Adult:
Full Name of Child 1:
Date of Birth of Child 1:
MM
/
DD
/
YYYY
Full Name of Child 2:
Date of Birth of Child 2:
MM
/
DD
/
YYYY
Full Name of Child 3:
Date of Birth of Child 3:
MM
/
DD
/
YYYY
Church Requesting Membership Transfer From:
Name of Church:
Church Address:
Church Phone Number:
If available, please provide a contact at the church:
Church Contact Name:
Church Contact Email or Phone Number:
Areas of Interest at Crossroads:
Please let us know if there are any areas that you might be interested in getting connected with at Crossroads. We will have a staff member contact you with more information.
Date attended Tea with Tim (if applicable)
MM
/
DD
/
YYYY
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