LifeChurch Central Membership Application

Your name *

Last name

Email address *

Phone number

Phone type

MobileHomeWorkOther

LifeChurch Central Membership Application *

I am becoming a Member of LifeChurch Central for the first time

I am renewing my membership at LifeChurch Central

Are you the Head of the Household? *

Yes

No

Marital status *

Select…SingleMarriedWidowedOtherDivorcedSeparated

Birthdate *

Have you accepted Jesus Christ as Lord and Savior? *

Yes

No

Have you been baptized in water?

Yes

No

Address *

HomeWorkOther

Country

Country

Street address

Apt/unit/box (optional)

City

State

Postal code

Do you have any children under the age of 18? *

Yes

No

Submit

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