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Port City Church
Membership Application
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Full Name
Your answer
Maiden Name or Alias
Your answer
Complete Address
*
Your answer
Your Birthday
*
MM
/
DD
Date and place of last church attended
*
Your answer
Date Converted
*
MM
/
DD
/
YYYY
Date Baptized in the Holy Spirit
Your answer
Date baptized in water
MM
/
DD
/
YYYY
Marital Status
*
Married
Single
Widow(er)
Separated but not divorced
Divorced and remarried
Divorced but not remarried
Name of Spouse
Your answer
Anniversary
MM
/
DD
Is your spouse a born again Christian?
Yes
No
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Dependent Children
Please give full name and birthday (month/day)
Your answer
Comments
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*All potential members must have attended PCC 3 months prior to membership.
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