Membership Application

Please submit one for each water baptized member over 18 in the family. For couples, please submit for each spouse.

Your name *

Email address *

Contact Information

Address *

Phone Number *

Birthday *

Gender *

If a question does not apply to you, please write 'N/A'.

Water Baptism Date *

Are you baptized with the Holy Spirit? *

Yes

Spouse's Name *

Type N/A if this is not applicable to you

Your last name before marriage *

Name/Date of Birth/Place of Birth/Comments

Type N/A if this is not applicable to you

Attach a photo *

Attach a photo of yourself or your family so we can see who you are

No files currently selected

Add up to 5 files. Maximum file size 10 MB.

Upon submission, I will be contacted by the PRC Staff for a meet and greet.

Your signature *

Today’s Date *

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