Peter's Rock Membership Form

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* 1. Membership Classification

Member

New Believer

Watch Care

College Student

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* 2. Date of Membership

Date / Time

Date

Time

AM/PM

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* 3. Given Name

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* 4. Preferred Name

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* 5. Job/Occupation

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* 6. Birthday

Date / Time

Date

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* 7. Sex

Male

Female

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* 8. Marital Status

Single

Married

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* 9. Spouse Information (if married)

Given Name

Preferred Name

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* 10. Spouse's Job/Occupation

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* 11. Spouse's Birthday (if married)

Date / Time

Date

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* 12. Address

Street Address

City

State

Zip Code

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* 13. Contact Information

Home Phone

Work Phone

Cell Phone

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* 14. Spouse's Contact Number

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* 15. Emergency Contact Information

Emergency Contact Name

Emergency Contact Number

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* 16. Children 18 and under in your household

Child 1 Name

Child 1 Birthday

Child 1 Sex

Child 2 Name

Child 2 Birthday

Child 2 Sex

Child 3 Name

Child 3 Birthday

Child 3 Sex

Child 4 Name

Child 4 Birthday

Child 4 Sex

Child 5 Name

Child 5 Birthday

Child 5 Sex

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* 17. What ministries or activities would you like to be involved in or have more information about?

Ministry or Activity

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* 1. Membership Classification

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* 2. Date of Membership

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* 3. Given Name

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* 4. Preferred Name

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* 5. Job/Occupation

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* 6. Birthday

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* 7. Sex

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* 8. Marital Status

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* 9. Spouse Information (if married)

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* 10. Spouse's Job/Occupation

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* 11. Spouse's Birthday (if married)

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* 12. Address

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* 13. Contact Information

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* 14. Spouse's Contact Number

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* 15. Emergency Contact Information

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* 16. Children 18 and under in your household

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* 17. What ministries or activities would you like to be involved in or have more information about?

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* 18. What ministries or activities have you been involved in either prior to joining Peter's Rock or while at Peter's Rock?