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Disciple Information Form
Your Journey has begun. We'd like to get to know you.
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Select the worship location you would like to be a member of.
*
Charlotte, NC
Rock Hill, SC
Date Joined / Current Date
*
MM
/
DD
/
YYYY
Address
*
Your answer
City, State and Zip Code
*
Your answer
Email
*
Your answer
Phone
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
I am:
*
Male
Female
I am:
Single
Married
Widowed
Divorced
Clear selection
I have expertise / experience in the following areas
*
Choose all that apply
Administration
Counseling
Education
Leadership
Media
Music
Project Management
Technology
Other:
Required
Spouse Name
Your answer
Spouse date of Birth
MM
/
DD
/
YYYY
Wedding Anniversary Date
MM
/
DD
/
YYYY
Children:
Please list their names and birthdates
Your answer
What brought you to Blessed Harvest Nation?
*
Your answer
Why did you join Blessed Harvest Nation?
*
Your answer
Did you ever attend a church meeting or Bible Study before joining?
*
Your answer
Have you accepted the salvation that God has for you through Jesus Christ?
*
Have you committed your life to the service of God?
Yes
No
Have you been baptized?
*
Yes
No - If No we will include you in our next Baptism
Do you desire to abide by the Blessed Harvest Discipleship Covenant and be a part of this fellowship?
*
Yes
No
Required
Thank you for your cooperation in completing this form. Welcome to the BHN Discipleship Journey.
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