Tabernacle Missionary Baptist Church - Membership Application
Dear Applicant:

In order that our records for all members are accurate and complete we would like you to complete this form to be filed in the Clerk's Office. Please complete as much of the information as you can. All of the information below is necessary for our records. Your cooperation is very much appreciated and we thank you.

Dea. Jerry Moses, Church Clerk
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First Name *
Middle Name
Last Name *
Maiden Name (if applicable)
Email Address of Applicant
Address *
City *
State *
Zip Code *
Home Phone *
Enter ten-digit phone number (with area code)
Cell Phone
Enter ten-digit phone number (with area code)
Work Phone
Enter ten-digit phone number (with area code)
Gender *
Birth Date: *
Please enter two digits for month, two digits for day, and four digits for year - MM/DD/YYYY
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