New Member Information
Please fill out the following information. If you have any other questions, please feel free to contact the church office or Pastor Mike. If you don't know some information, that's OK.

Fill this out separately for every adult who wishes to join (e.g. both husband and wife need to fill out this form)
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Name (include middle and maiden name)
Birth date:
Address (include city, state and zip)
Home Phone Number:
Cell Phone Number:
Email Address:
What is your preferred manner of communication?
Clear selection
I desire to be a/n
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If you are a snowbird, list your other address and include the dates you reside at that address:
When were you baptized?
What church were you baptized in? (Church, city, and state)
When were you confirmed?
What church were you confirmed in? (Church, city, and state)
If you are currently a member of another church, please indicate what church and where.
Are you currently married?
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Name of spouse:
Wedding Date:
MM
/
DD
/
YYYY
Church affiliation of spouse:
If there are any children who are joining Bethany with you, please list them below: (include name, birthdate and baptismal date)
Did you serve or do you currently serve in the Armed Forces?
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Do you wish to make contributions to the ministry of Bethany Lutheran Church via giving envelopes or online giving?
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Why do wish to become a member of this church?
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