Name:

Address (street, city, zip):

Email:

Phone (work): (home)

Cell phone(s):

Birthdate (mmddyy):

Children (names, ages):

Have you been baptized in any Christian church? yes no

If your answer is "yes," in what church were you baptized and when?

Baptized:

When:
(If you have not been baptized, then you will join the church through adult baptism. Pastors Dan, Todd or Lynne will need to meet with you. Please call and arrange a time.)

Are you currently a member of another church? yes no
(If your answer is "yes," please provide complete information about the church and yourself so that we can send for a letter of transfer.)

Church name:

Address (street, city, zip):

Phone:

Email:

By what name does this church know you?

(If you have been baptized and are not a member of another church then you will come into membership by reaffirmation of faith.)

Have you served as a deacon or elder in the Presbyterian Church? yes no