Member/ Regular Attender Contact Information Form | First Baptist Church, Rockville, Indiana

Name *

First

Last

Spouse Name *

First

Last

Children (Name, Ages, Birthdate, Grade, & School)

Primary Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Secondary Phone

Primary Email *

Secondary Email

Preferred Contact Method (Please check all that Apply) *

Birthday (MM/DD/YY *

Anniversary (MM/DD/YY *

Ministry Involvement Currently or Future (Please check all that Apply) *

Are you interested in more information on the ministries selected above *

Do you currently recieve church newsletters or updates? *

Involvement Name &

Do you currently receive church-wide Prayer requests or alerts? *

If you do not receive newsletters, updates, church-wide prayer requests, or alerts. Would you like to? (Check all that Apply)

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Phone Number *