New Member Intake Form Name First Name Last Name Gender Male Female Age Group 18-29 30-44 45-49 60+ Under 18 Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Marital Status Single Married Divorced Widowed Separated Number of Children 0 1 2 3 4 5 6 7 8 9 10 Occupation * Are you a new Christian? Yes No Are you a former member of another church? Yes No Would you like to opt-in to receive email and text notifications? * Yes No Notes/Comments I certify that the information is complete and accurate to the best of my knowledge. * A New Member Orientation, which is a 3 to 4 week session about what you can expect as a member, will be required to be completed in order to confirm your membership. Information will be forwarded to you at the email address you have provided above. I also understand that my membership is not confirmed until I have completed the New Member Orientation. * Thank you!
