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Membership Intake Form
By open confession, you have chosen to unite with Pleasant Grove Missionary Baptist Church in Christian fellowship. Please complete the following information and submit.
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Email
*
Your email
First and Last Name
*
Your answer
Sex
*
Male
Female
Prefer not to say
Other:
Parent(s) Name (if under 18 years of age)
Your answer
Parent(s) Membership Status
Member
Non-Member
Clear selection
Address
*
Your answer
City, State, and Zip Code
*
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Email Address
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
If married, anniversary date
MM
/
DD
/
YYYY
Please select how you wish to unite in fellowship with the Body of Christ.
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Salvation
Candidate for Baptism
Restoration/Rededication
Christian Experience or By Letter
Prayer
Reinstatement of Membership
Crisis Response (Mental Health, Homelessness, Addiction, Domestic Violence, Finances)
Do you wish to unite with our church family here at Pleasant Grove Missionary Baptist Church (PGMBC)?
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Yes
No
Maybe
Are you presently a member of PGMBC?
*
Yes
No
If you are uniting by Christian Experience or By Letter, please provide us with the following information: Pastor's Name, Name of Church, Church Address including City, State, and Zip.
Your answer
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