New Member Registration Form

Name(Required)

First Middle Last

Name You Prefer

Maiden Name

Marital Status

Spouse's Name

New Member Class Date(Required)

If you need childcare please list below the name of child(ren) and their age.

What service would you like to be recognized at?

Address(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone(Required)

Cell Phone(Required)

Business Phone

Date of Birth(Required)

Email(Required)

Enter Email Confirm Email

Do you have any food allergies? So yes, what are they?

Children

Children under the age of 21

Child 1 Name

First Middle Last

Is Child 1 a Church Member?

Child 1's Birthday

Child 1's Grade

Is Child 1 Baptized?

Does Child 1 have any food allergies? So yes, what are they?

Child 2 Name

First Middle Last

Is Child 2 a Church Member?

Child 2's Birthday

Child 2's Grade

Is Child 2 Baptized?

Does Child 2 have any food allergies? So yes, what are they?

Child 3's Name

First Middle Last

Is Child 3 a Church Member?

Child 3's Birthday

Child 3's Grade

Is Child 3 Baptized?

Does Child 3 have any food allergies? So yes, what are they?

Child 4's Name

First Middle Last

Is Child 4 a Church Member?

Child 4's Birthday

Child 4's Grade

Is Child 4 Baptized?

Does Child 4 have any food allergies? So yes, what are they?

Tell Us about You!

Place of Employment

Professional Skills / Experiences

I wish to become a full member of Westminster Presbyterian Church through…(Required)

Have you been Baptized?(Required)

Name of Previous Church

(If you are transferring from any other Church)

Address Previous Church

Street Address Address Line 2 City State ZIP Code

(If you are transferring from any other Church)

Alert 1/4:

Alert 2/4:

Alert 3/4:

Alert 4/4:

New Member Registration Form