First Name:
Last Name:
Home Phone #:
Cell Phone #:
Mailing Address:
City:
Zip Code:
Email:
Marital Status:
Married
Single
Divorced
Widowed
Age Group:
20-29
30-39
40-49
50-59
60-69
70+
Occupation:
Church now Attending:
Children's names and ages who NEED childcare:
Child 1 Name:
Register them for the Children's Program:
Select One
YES
NO
Child 2 Name:
Select One
YES
NO
Child 3 Name:
Select One
YES
NO
Register them for the Children's Program:
Child 4 Name:
Select One
YES
NO
Register them for the Children's Program:
Birthdate: mm/dd/yy
Register them for the Children's Program:
Bible Knowledge:
None
Little
Average
Familiar
Ministries you are currently serving in:
Is there any area within Women's Ministries where you are interested in serving?:
Fall 2010-2011 Studies
Wednesday Morning:
Select One
Ephesians
Precepts
Fundamentals of the Faith
Select One
Ephesians
Precept
Wednesday Evening:
Thursday Noon:
Book:
Twelve Ordinary Men