Bethel Membership Survey

Please take this brief survey on your church history, information, and interests.

Personal Information

Name (Include: First, Last and Maiden if applicable)

*

Address

*

Phone(s)

*

Email(s)

*

This address will receive a confirmation email

Would you like to be added to Bethel's email list?

*

Please select all that apply.

Yes No

Would you like to be added to Bethel's annual printed directory?

*

Please select all that apply.

Yes No

Would you like access to Bethel's online directory?

*

Please select all that apply.

Yes No

Date of Birth

*

Marital Status

*

Spouse (Include maiden name if applicable)

Child(ren): [Full names, birthdates (Month, Day, Year), baptized? (y/n)]

*

Past Church Affiliations (N/A if none)

Have you been baptized? (Date, Church, Denomination):

*

Have you been a communicant member of a church? (Date, Church, Denomination):

*

Name of the last church you were attending:

*

Are you currently a member of a church? Please list name:

*

Please select one option.

Yes No

Have you ever been under church discipline?

*

Please select one option.

Yes No

Description

Please take this brief survey on your church history, information, and interests.

Please Fix the Following

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