Church Membership Form

PLEASANT WORD CHRISTIAN CENTER MEMBERSHIP ENROLLMENT FORM

All information on this form is strictly confidential
Full Name *

First Name Last Name
Gender *

Male Female
Date of Birth *

Month Day Year
E-mail *
Mobile Phone Number

Prefix Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Have you been member before? *

YES NO
If Yes, When did you join?
What are some of your talents and/or giftings? *
What role do you want play in your church, if any?
Are you a born again Christian? *

YES NO
If YES, Could you share with us a short testimony of your salvation?
Child (ren) Names & Ages
Should be Empty:

PLEASANT WORD CHRISTIAN CENTER MEMBERSHIP ENROLLMENT FORM