Become a New Member Today

Your Personal Contact Information

First Name

Last Name

Phone *

Email *

Date of birth *

Address *

City *

State *

Postal code *

Please Provide The Best Answer To The Questions Below.

What's your reason for wanting to join?

Baptism (I'd like to take steps to getting Baptized)

Christian Experience (I am really looking to call a church "Home")

Rededication (I am looking to get reconnected back into Church)

Have You Accepted Christ As Your Savior?

Have you been Baptized since you believed?

Are you willing to receive a Ministry Visit or Phone Call?

Are you in need of counseling?

What Date Would You lIke To Be Baptized?

Emergency Contact Information

Name of your Emergency Contact

Emergency Contact Phone Number

SMS Optin *

Opt In to Receive SMS Notifications, Alerts & Occasional Marketing Communication

By submitting this form, you agree to receive recurring automated marketing messages, including cart reminders, at the phone number provided. Consent is not a condition of purchase. Reply STOP to unsubscribe. Message frequency varies. Msg & data rates may apply. Your Privacy is our priority. Your information will not be shared.

Appleton Automation