Page 69 | Crossroads For Life Ministries

Name (Required)

Email Address (Required)

Do you want to become an E-Member at CFLM? (Required)

Majority of worship service attendance will occur online.

Demographics

First Name (Required)

Last Name (Required)

What is your Date of Birth? (Required)

Email Address (Required)

Address (Required)

Country

Phone Number (Required)

Please list best form of contact

Family

Are you married? (Required)

If yes, please list Spouse name

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

Wedding date (MM/DD/YYYY)

Do you have children? (Required)

List all children eighteen (18) years old and/or younger

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

Additional Information

Are you employed? (Required)

Employer's Name

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

Emergency Contact Name

Emergency Contact Number

Would you like to be contacted quarterly by the ministry? (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 participating in an orientation? (Required)

I am good at... (Required)

Choose your passion!

Crossroads For Life Ministries