Name: *

First Name

Last Name

Phone: *

(###)

###

####

Spouse's Name (if applicable)

First Name

Last Name

Are you a Christian? *

Have you believed in Jesus Christ as your Lord and Savior?

Yes

No

Have you been baptized as a believer in Jesus Christ *

If unsure, select I don't know.

Yes

No

I don't know

If married, has your spouse been baptized as a believer in Jesus Christ

If not married, leave blank

Yes

No

I don't know

Are you connected to a City Group? *

To become a member, you must be connected to a City Group

Yes

No