Membership Profile

Membership Profile

Your information is confidential. We don't share it with anyone. Only for Pastor's use.
Name *

First Name Last Name
Birthday *

/ Month / Day Year
Sex *

Male Female
Marital Status *
Spouse's Name

First Name Last Name
Anniversary

/ Month / Day Year

Home Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Mail Address (if different than home)

Street Address
Street Address Line 2
City	State
Zip Code	Country

E-mail *
Cell Phone *

- Area Code Phone Number
Home Phone

- Area Code Phone Number
Work Phone

- Area Code Phone Number
Occupation / Employer *
Former Church Member? *

Yes No
Former Church name
Would you like CRCC to notify your former church for Membership Transfer?

Yes No
Baptized in water *

Yes No
Baptism Date
If don't remember the exact date, please type the approximate year.

Children

	Name	Birthday	Baptized? (Y/N)
1
2
3
4
5

Profile picture
Please, if possible, upload here a profile picture of yourself alone. (Pic size max 2Mb)

Your Testimony

Finally, in your own words, write your personal testimony and how you came to know Christ as your personal Savior and what you are doing today to help strengthen your walk with God.
Take as much room as needed... *
Should be Empty: