East Main STreet church of god

Church Membership

Thank you for your interest in joining our church family! Please complete the form below and we’ll be in touch.

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First Name

Last name

Phone

Address

City

State

Postal / Zip Code

Date (YYYY-MM-DD)

Would you like to opt in for text updates?(required)

Yes No

Spouse First Name (if also joining)

Spouse Last Name

Spouse Date of Birth (YYYY-MM-DD)

Spouse Phone

Spouse Email

Anniversary

Please list any “MINOR” children’s names, gender, birthdays and contact number (if applicable). Example: John Henry Smith, male, 3/6/2014, no cell phone

Please list any other family connections to current members of our church, including their name and relation to you. Example: Jane Smith, grandmother

Are you a member of another church that we need to notify?

Yes No

If yes, please include church name, address and phone number.

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