Membership Application
Please fill out this form and click submit.
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Date of Birth
*
Gender
*
Are you married?
*
Please select one option.
Married
Single
Widowed
What is your spouse's name? (Both spouses will need to complete an application.)
Have you repented and trusted Christ as your Lord and Savior?
*
Please select one option.
Yes
No
Not sure
If yes, when?
*
Have you been baptized by immersion?
*
Please select one option.
Yes
No
Are you currently a member of a church?
*
Please select one option.
Yes
No
If so, provide an e-mail address, name, and city of the church.
Have you attended Introducing Immanuel?
*
Please select all that apply.
Yes
No
Partially
Why do you want to join Immanuel?
*
Are you currently attending a Gospel Community Group?
*
Please select one option.
Yes
No
If yes, whose group have you been attending?
What is your occupation?
*
Please list any children and their dates of birth.
Submit
Description
Please fill out this form and click submit.
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