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 & Last)
Maiden Name (if applicable)
Preferred or Nickname
Sex: (Check one) / Male  Female  / Male  Female 
Address:
City, State / Zip:
Birthday: (yr. optional) / Date: / Date:
Marital Status & Wedding Date: (if applicable)
Baptized (y/n) if yes date:
Confirmed (y/n) if yes date:
Alternate Address
Address:
City, State / Zip: / From: To: / From: To:
Home Phone: / ( ) - Unlisted?  / ( ) - Unlisted? 
Cell Phone: / ( ) - Unlisted?  / ( ) - Unlisted? 
Work Phone: / ( ) - Unlisted?  / ( ) - Unlisted? 
Email:
Alternate Email:
Occupation:
Employer (company name):
School Grade (if applicable):
Church Member (y/n):
If Yes, Year Joined & How Joined (transfer, baptized, etc…)
Church Background
church denomination raised in

Unmarried Children Living at Home

Name (first, middle, last) / Birth Date / Grade / Baptized / Class
Date: / yes  Date:
Date: / yes  Date:
Date: / yes  Date:
Date: / yes  Date:

Skills / Interests

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

H S H S H S

  Administration /   Drama /   Music (other than piano or singing)
  Artist /   Electrical /   Piano
  Caregiver /   Fundraising /   Singing
  Carpentry /   Golf /   Teaching
  Computers / Electronics /   Guitar /   Ultimate Frisbee
  Cooking /   Handbells /   Other:

Positions Held (current or in the past)

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

H S H S H S

  Board of Adult Christian Ed /   Board of Trustees /   Moderator / Assistant
  Board of Christian Education /   Chaperone (youth trip, etc…) /   Treasurer
  Board of Christian Stewardship /   Christian Service & Outreach /   ROC
  Board of Deacons /   Church Council /   Fundraising
  Board of Music Ministry /   Church School Teacher /   Other

Activities & Bible Study

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

H S H S H S

  Adult Confirmation Class /   Annual Golf Fundraiser /   Strawberry Festival
  Bible Study / Church School /   GIST (God is Still Talking) /   Thursday Morning Study Group
  Choir /   Habitat for Humanity /   Ultimate Frisbee
  Columbus House /   Handbells /   Vacation Bible School (VBS)
  Covenant to Care /   Nursing Home / Homebound /   Woman’s Fellowship
  Family Night Dinner /   OCC Nursery School /   Youth Group
  Fellowship Breakfast /   Prayer Line /   Other:
  FISH (food bank program) /   Spiritual Formation Group

Willing to Serve

H S H S H S

  Assistant /   Liturgist /   Usher
  Board or Committee Member /   Music /   Visitation
  Finances /   Nursery /   Youth Group / Mentor
  Greeter /   Teaching /   Other:

Preferred Communication Method

H S H S H S

  Email /   US Mail /   Phone

Service Attended

H S H S H S

  8 am (early) /   10 am /   Varied

Hobbies / Interests (For example; pets, reading, nature walks, basketball, knitting, etc…): ______

______

Comments: ______

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