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Are you a born again spirit-filled believer? Have you been attending or viewing our services faithfully for a while? Do you identify with the vision of this church? Can we count on you just as you are counting on us?
Please include your email and phone contact.

Identification:



Address

Mailing Address

Contact Info




Important Data:



Occupational Information:


Employed   Self-Employed   Unemployed

Salvation Information



Yes   No

Profession of Faith
Transfer

Previous Church Information

Yes   No   Not Sure
Yes   No

By submitting this form, you are agreeing to our vision, mission and core values.