Church Membership Form

PLEASANT WORD CHRISTIAN CENTER MEMBERSHIP ENROLLMENT FORM

All information on this form is strictly confidential
Full Name*

First NameLast Name
Gender*

MaleFemale
Date of Birth*

MonthDayYear
E-mail*
Mobile Phone Number

PrefixNumber
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Have you been member before?*

YESNO
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?*

YESNO
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