Langley Church Contact Information
Langley Avenue Membership Form
Name (Full name and title) *
Email *
Address (Please include city, state, and zip code) *
Phone number (Please include area code) *
Birthday (Month and Day - Only)
Wedding Anniversary (Month, Day, Year)
Emergency Contact  Full Name
Emergency Contact Phone Number (Include Area Code)
Children Names (Please list full name)
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Name 1
Name 2
Name 3
Name 4
Name 5
Name 6
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What is your preferred communication?
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What Ministry Are you a member of?  
Ministry Options:  Communion Board; Deacon Board;  Door of Hope;  Focus on Giving; Junior Usher’s; Music and Performing Arts (Choir, Band, Praise Dancers, etc.); Nursing Center;  Outreach; Intercessory Prayer;  Men’s Group;  Mission Workers;  New Converts and New Members;  Nurses Guild;  Project Care;  Special Events Committee;  Sunday School; Vacation Bible School; Visitation Team;  Women’s Ministry; and Young Mens Group.
What Ministry are you interested in joining?
Ministry Options:  Communion Board; Deacon Board;  Door of Hope;  Focus on Giving; Junior Usher’s; Music and Performing Arts (Choir, Band, Praise Dancers, etc.); Nursing Center;  Outreach; Intercessory Prayer;  Men’s Group;  Mission Workers;  New Converts and New Members;  Nurses Guild;  Project Care;  Special Events Committee;  Sunday School; Vacation Bible School; Visitation Team;  Women’s Ministry; and Young Mens Group.
Do you have any of the following medical concerns our nurse should be aware of ? (Please note this information is highly confidential, according to HIPPAA Privacy Rules. If yes, please check the correct box (s) and  speak with Sis. Ann Wormack privately.)
Have you participated in New Member Class? *
Have you been baptism in the Church of God?
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