Name
*
First Name
Last Name
Primary Birthdate
*
MM
DD
YYYY
Personal Status
Single
Engaged
Married
Divorced
Widow/Widower
Spouse (If Applicable)
First Name
Last Name
Spouse Birthdate
MM
DD
YYYY
Wedding Anniversary
MM
DD
YYYY
Child(ren)'s Name(s) * Ages * Birthdays
Email Address
*
Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Primary Phone
*
(###)
###
####
Specify Primary Phone
*
Home
Cell/Mobile
Work
Other
Other Phone
(###)
###
####
Additional Desired Contact
Please Call Me.
Please Email Me.
Please Text Me.
Please Confirm GS Alerts Now.
Get | Stay Alert Text or Emails
GS Alerts* - If you'd like to be included in email/phone alerts for monthly news, special announcements, and/or emergencies, please indicate which number(s) you prefer to be contacted. GS alerts keep adherents INFORMED about new events, special announcements, and/or whenever an emergency arises due to weather and the cancellation of local church services.
Yes, please add my home number to Get | Stay Alert
Yes, please add my mobile number to Get | Stay Alert
Yes, please add both home and mobile numbers to Get | Stay Alert
I do not wish to receive alerts at this time.
Check all that apply
Optional
I've repented and given my life to the Lord
I've been baptized by full immersion in the name Jesus
I've been baptized by full immersion in the name of the Father, Son & Holy Spirit
I have not been baptized yet by full immersion
I have received the New Birth experience
I'd like to know more about the New Birth experience
I live an active Christian life and attend church regularly
I'd like to learn more about the Plan of Salvation
Tell us MORE about your Christian Experience
Optional
How did you hear about us?
Family and Friends
Word-of-Mouth
Internet
Publications or Other (Specify Below)
Other
Directory | Publishing
*
Check if you give Zion City International Church Ministries, Inc. and its affiliates permission to publish information on this document in our directory and/or use your name, photography in promotional materials, etc.
Please publish MY HOME ADDRESS ONLY in the church directory.
Please publish MY HOME PHONE ONLY in the church directory.
Please publish MY NAME ONLY in the church directory.
I DO NOT grant permission for publishing of any information on this form!
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