LICC New Member Form
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Region (enter geographic location) *
Ministry *
Bible Talk *
First Name *
Last Name *
Male/Female *
Spiritual Birthday *
MM
/
DD
/
YYYY
Physical Birthday *
MM
/
DD
/
YYYY
Phone Number *
xxx-xx-xxx-xxx
Email Address *
Address *
Weekly Pledge *
Nationality
Are you in employment? This is for Gift Aid purposes *
Other Information
Confidentiality *
LICC will ensure that information provided in confidence is kept confidential and disclosed only in the circumstances permitted by it's policies and procedures. LICC will ensure that it's members do not have access to certain personal records without first getting that person’s consent.
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