Member Services User InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* Special RequestsElectronic Signature*By typing my name below, I certify that all information is correct. Member ServicesMember Services Requested*Please check all that apply Baby Blessing Baptismal Candidate Profession of Faith Candidate Transfer of Membership Baby BlessingRequested Date of Ceremony* MM slash DD slash YYYY Baby’s Name* First Last Baby’s Gender*FemaleMaleBaby’s Date of Birth* MM slash DD slash YYYY Mother’s Name* First Last Father’s Name* First Last Baptismal or Profession of Faith CandidateName* First Last Date of Birth* MM slash DD slash YYYY Previous Church Attended* Favorite Bible Scripture* Transfer of MembershipName First Last Date of Birth* MM slash DD slash YYYY Church Transferring From* Church Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
