Membership Application

Title

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Gender

Birthdate

Email

Phone Number

Marital Status

Date of Marriage

Date you were Baptized

Where were you baptized & in what name were you baptized?

Have your received the Holy Ghost with evidence of speaking in tongues?

Yes

No

If so, what was the date and what was the name of the church?

Emergency Contact

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

If you are coming from another Apostolic Church, have you obtained a transfer letter?

Yes

No

If no, please state the reason

Name of former Pastor

Name of former Church

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

When did you choose to break your fellowship?

Your responsiblities at your previous church

Occupation