Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

List the Names of Other Family Members

If you are currently a member of another church please provide the name of the church

If you have been baptized, When were you baptized (doesn’t have to be exact) & Where were you baptized?

Please Provide a Brief Written Testimony on How You Came to Faith in Christ

Please Indicate Your Willingness to Assent to the Following Membership Vows:

1. Do you acknowledge yourself to be a sinner in the sight of God, justly deserving His displeasure, and without hope save in His sovereign mercy?

2. Do you believe in the Lord Jesus Christ as the Son of God, and Savior of sinners, and do you receive and rest upon Him alone for salvation as He is offered in the Gospel?

3. Do you now resolve and promise, in humble reliance upon the grace of the Holy Spirit, that you will endeavor to live as becomes the followers of Christ?

4. Do you promise to support the Church in its worship and work to the best of your ability?

5. Do you submit yourself to the government and discipline of the Church, and promise to study its purity and peace?