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Title Select Mr. Mrs. Ms. First Name * Middle Initial Last Name * Suffix Sr. Jr. II III IV E-mail Address * Cell Number * Home Number Address * Address Line 2 City * State * Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * If under 18: Parent or Guardian First Name Last Name Parent or Guardian Address If Different From Above Address City Zip Code Address Line 2 State Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Number of Children in Same Household Please Select 1 2 3 4 5 6 Child 1 Name Child 1 Birthday Date of Worship Service Joined Time of Service Joined 7:45am 10:00am Other Membership Status Candidate for Baptism Christian Experience Restoration/Re-dedication Watch Care Membership Number Status I know my Membership Number. 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N/A Select Deacon Based On Your Last Name Select One A – Cl Co – F G – H I – L M – O P – R S – Wa We – Z See Full List of Deacons here Occupation Marital Status Select Single Married Engaged Separated Divorced Widowed Don't Want To Disclose Interests/Hobbies (Select All That Apply) Adventurous Sports//Sports Blogging/Writing Blogging/Chatting/Texting Collecting Antiques Cooking Crafts/Knitting/Sewing Dancing Homemaker Painting Photography Reading Shopping Tutoring Traveling Watching TV/Watching Movies Playing Computer Games/Playing Cards Outdoor Activities/Fishing/Horseback Riding/Bike Riding Other Skills/Talents Ministry Interests Empowerment Fellowships Comfort & Care Youth Outreach and Missions Discipleship and Development Membership Services In Case of Emergency Emergency Contact Name Emergency Phone Number Emergency Relationship Relatives or Friends at Freedom Full Name Full Name Phone Number Phone Number Relationship Relationship Additional Comments: Is there anything else you'd like us to know? This information will not be transferred, sold, or given to any third party; and will be used for internal recordkeeping purposes only.
