Sample Church Membership Form

Please fill in these blanks to obtain your data record. Responses will be kept confidential. The objective is to
get to know him better and to offer him an enriched spiritual follow-up.

PERSONAL INFORMATION
Name:_______________________________________________________________________________
Last name:____________________________________________________________________________
Date of Birth_____/_____/______ Current Date:___/_____/_________
Address:
City:,
Neighborhood:
Cell:
Phone: (home)
E-mail _
____Married Anniversary:_______/_____/_ Marital Status: Single
Spouse:________________
Sons:____Yes____No How many?_______Age:________________________________
(Please mention! names of each member of the family on the back)
Studies and Degrees Achieved______________________________________________
Profession / Occupation:_________________Tel. of Trab:________________________
Religious influence or background__________________________________________
How did you get to know the church? Who invited you?

Since when did you start attending this congregation? First time visitor?

Date you have accepted Jesus as your Savior___________/______________________/

Have you participated in a Baptism Course?__Yes___No
Baptized_____Yes____No Place / Date:_______________________________________
Please write a brief testimony of your conversion to Christ:

Please complete on the back:

- What are some of the reasons why you would like to join as a "member" of our local church? * What are
your most frequent struggles? Would you like to receive personalized counseling?