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MEMBERHIP

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First Name*

Last Name*

Address*

Address 2*

City*

State/Province*

Zip/Postal Code*

Email Address*

Phone

Date of Salvation*

Number of Children (living at home)*

Date of Water Baptism*

Previous Church Membership (if any)*

Other Info*

New

Transfer

Re-Instated

Regular Attendance

Regular Attendance Began*

Date Submitted*

Date Approved - Office Use Only

By filling out this application you are stating that you have read and are in agreement with the Highway Church Statement of Essential Truths and the Local Church Constitution and agree to live in harmony with this fellowship.*

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