Page 12 | Crossroads For Life Ministries

Name (Required)

Email Address (Required)

Do you want to become a member of this ministry? (Required)

Demographics

First Name (Required)

Last Name (Required)

Date of Birth (Required)

Email Address (Required)

Address (Required)

Please Include: City, State, Zip Code, Apt/Unit/Suite Number

Phone Number

Please list best form of contact

Family

Are you married? (Required)

If yes, please list Spouse name

List First/Last Name and Date of Birth (MM/DD/YY)

Wedding Date (MM/DD/YYY)

Do you have children? (Required)

List all children under eighteen (18) years old and younger

List First/Last Name and Date of Birth (MM/DD/YY)

Additional Information

Are you employed (Required)

Employer Name

If self-employed, please list name of your business.

Emergency Contact Name

Emergency Contact Number

Would you like to be contacted monthly? (Required)

The Discipleship Ministry seeks to maintain member engagement by reaching out periodically for prayer request and provide important ministry updates

Would you be interested in completing discipleship courses? (Required)

These classes are offered to new members and anyone actively involved in ministry

I am good at...

Choose your passion!

I am interested in... (Required)

For instance, feeding the hungry, serving the homeless community, teaching, dancing, etc.

Crossroads For Life Ministries