Membership Information

	Head of Household	Spouse
Title: (Circle one)	Mr. Mrs. Miss. Ms. Dr. Rev. Other _____	Mr. Mrs. Miss. Ms. Dr. Rev. Other ______
Name: (First - Middle or Maiden - Last)
Sex: (Check one)	Male o Female o	Male o Female o
Birthday: (yr. optional)	Date: ______________	Date: ______________
Preferred or Nickname
Address: City, State / Zip:	_________________________________	__________________________________
Alternate Address Address: City, State / Zip:	From: ___________ To: ____________ _________________________________	From: __________ To: ___________ _________________________________
Home Phone:	( ) - Unlisted? o	( ) - Unlisted? o
Cell Phone:	( ) - Unlisted? o	( ) - Unlisted? o
Work Phone	( ) - Unlisted? o	( ) - Unlisted? o
Email
Pager #:	( ) - Unlisted? o	( ) - Unlisted? o
Fax #:	( ) - Unlisted? o	( ) - Unlisted? o
Extra Phone:	Unlisted? o	Unlisted? o
Marital Status:
Anniversary Date:	Date: ______________	Date: ______________
Occupation:
Employer:
Member Status:
Church Background
Sunday School Class:
Baptized:	yes o no o Date: ___________	yes o no o Date: ___________

Children

Name (first, middle, last)	Birth Date	Grade	Baptized	Class
	Date: ________		yes o Date: _______
	Date: ________		yes o Date: _______
	Date: ________		yes o Date: _______
	Date: ________		yes o Date: _______
	Date: ________		yes o Date: _______
	Date: ________		yes o Date: _______

Skills

(Please check all that apply, H=Head of household, S=Spouse)

H S H S H S

o o Administrator	o o Cooking	o o Pianist
o o Artist	o o Drama	o o Singing
o o Caregiver	o o Electrical	o o Singing
o o Carpentry	o o Guitar	o o Teaching
o o Computer	o o Music	o o

Leaders

(Please check all that apply, H=Head of household, S=Spouse)

H S H S H S

o o Choir Director	o o Treasurer	o o
o o Deacon	o o Worship Leader	o o
o o Interim Board	o o	o o
o o SS Superintendent	o o	o o

Activities

(Please check all that apply, H=Head of household, S=Spouse)

H S H S H S

o o Boys Club	o o	o o
o o `Home Schoolers	o o	o o
o o Young Adults	o o	o o
o o Youth Groups	o o	o o

Spiritual Gifts

(Please check all that apply, H=Head of household, S=Spouse)

H S H S H S

o o Administrations	o o Giving	o o Teaching
o o Encouragement	o o Mercy	o o
o o Evangelism	o o Prophecy	o o

Willing to Serve

H S H S H S

o o Assistant	o o Hospitality	o o Nursery
o o Finances	o o Maintenance/Grounds	o o Teaching
o o Greeter	o o Music	o o Visitation

Mail List

H S H S H S

o o	o o	o o
o o	o o	o o
o o	o o	o o

______________________________________

H S H S H S

o o	o o	o o
o o	o o	o o
o o	o o	o o

_______________________________________

H S H S H S

o o	o o	o o
o o	o o	o o
o o	o o	o o

Comments: ____________________________________________________________________________________

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