Membership Form

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General Info

Name

*

Address

*

Email

*

This address will receive a confirmation email

Cell Phone

*

Home Phone

Sex:

*

Please select one option.

Male Female

Date of Birth:

*

Marital Status

*

Please select one option.

Single Married Widowed Divorced

Anniversary Date:

My occupation is:

*

Business

*

I have the following expertise:

*

If you were active in any church in the past, please complete the following:

Years involved:

Name of church:

Where:

Member there?

Position of Service:

How would you describe your relationship to Christ?

Please select one option.

Seeker/curious Committed Christian New Christian Agnostic I'm not sure what I believe I've been a Christian for a while but I need to grow closer

Information on Family Members

Spouse's Name:

Date of Birth :

Does your spouse attend Northeast?

Please select one option.

Yes No

Children:

First Name:

Last Name:

Birthdate:

Live with you?

Attend NEAG:

Three Membership Requirements

Have you committed your life to Jesus Christ and trust Him for salvation?

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Have you been baptized by immersion (under water) after you committed your life to Christ?

*

Do you desire to abide by the Northeast Assembly Membership Covenant?

*

Description

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