Name(s) of first adult joining the church *

First Name

Last Name

Has this person been baptized? *

Yes

No

Name of additional adult joining church (if applicable)

First Name

Last Name

Has this person been baptized?

Yes

No

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Additional Phone (if applicable)

(###)

###

####

Please check here if you would NOT like your information to be listed in the church directory.

Please do NOT list me in the directory.