On-Site Membership

Please complete & submit the form below for On-Site Membership
Please select One *

Ms. Mrs. Mr.
Full Name *
First & Last Name
Gender *

Female Male
Phone Number *

Area Code Phone Number
Date of Birth *

Day Month Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail Address
Date of Water Baptism (not in Father, Son and Holy Ghost)

Month Day Year
Date
Church Where Baptized

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Date Received Gift of Holy Ghost

Month Day Year
Date
Church Where You Received Gift of Holy Ghost

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Do you attend church regularly? *

Yes No
Do you believe in Tithing? *

Yes No
Do you Tithe regularly? *

Yes No
Church home before joining GLA

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Reason for leaving
Type Here
Will you need transportation to church? *

Yes No
Marital Status *

Single Married Divorced Widow Widower
Husband/Wife's Full Name
First & Last Name
Are they members of GLA? *

Yes No
How did you come to hear about GLA?
Why do you want to join GLA?

Children Information

	Name	Age	DOB
Child
Child
Child
Child
Child
Child

Is membership required for your children?

Yes No
Will your children attend Sunday School regularly? If not, please explain?
Have you been engaged in church activities? If so, what kind?
REMARKS
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