Member Information Form

Whether you are a new member or an existing member, it is important for us to stay in touch with you. Please use the following form to provide your current contact information and/or update your membership record.

Select One
New Member
Existing Member
Frequent Guest

First Name

Last Name

Birth Date (MMDDYYYY)

Email

Mobile Phone Number

Address 1

Address 2

Country

City

State

Zip/Postal Code

What is your preferred contact ?method
Text Message
Email
Phone Call
Do Not Contact Me ( I do not wish to receive email, text or phone calls.)

Spouse First Name

Spouse Last Name

Spouse's Birthdate (MMDDYYYY)

Spouse's Email Address

Spouse's Phone Number

Wedding Anniversary Date (MMDDYYYY)

Please List Your Minor Children's Names, Birthdates, Current School Grade Below

Select Your Ministry Interests Below
Life Academy (Children & Youth)
Women of Life
Men's Ministry
Greeters/Hospitality
Outreach
Health & Wellness
Singles Ministry

Please review your answers before clicking submit.

Submit