Membership Inquiry Class Registration

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We're excited you are interested in learning more about membership in the PC(USA). Please complete this form (one person per form). Please include all information. You will receive a confirmation email before the class begins with a zoom link and any materials. Classes will be on Zoom Sep. 11, 18, and 25 (6pm-7pm). You will receive an email with the Zoom link.

First Name *

Middle Name

Last Name *

Maiden Name (if applicable)

Primary Phone *

Please use the format 555-555-5555

Primary Phone Type *

Cell Phone

Home Phone

Work Phone

Other:

E-mail *

Mailing Address *

City *

State *

Zip Code *

Birthdate *

YYYY

If you are currently or were previously a member of another Church, please enter the name of the church, including city and state (if none, type "none"). *

If you entered the name of a church above, are you currently a member or has your membership lapsed?

Currently still a member.

Membership has lapsed or listed as "inactive"

Clear selection

Have you been baptized? *

Yes

If you have been baptized, approximate date or year

Comments, questions, or additional information you would like us to know...

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