Membership Profile

Please complete this Profile as completely as possible!
One form per member.

INFORMATION
Fields marked with * are required.
   
Prefix

Rev. Min.. Deacon Deaconess Trustee Mr. Mrs. Ms.
Other

   
Suffix Sr. Jr. MD. PhD. DMin.
Other
   
Name


First Name*
Middle Name
Last Name*

   
Address
(Please include city, state and zip)		 Street:
City:
State: Zip:
   
Mailing Address
(if different from above)		 Street:
City:
State: Zip:
   
Home Phone: Fax: Cell Phone:
   
Preferred E-mail Address:*
   
Household Status Head of House Spouse Child - Youth Child - Adult
   
Date of Birth (mm/dd/yyyy)
   
Gender Male Female
   
Marital Status Married Single Widowed Divorced
   
Spouse First Name Middle Name Last Name
   
Please list names of Children (For children completing this form list parents/guardians)

First Name Middle Name Last Name
Child Adult

First Name Middle Name Last Name
Child Adult
First Name Middle Name Last Name
Child Adult
First Name Middle Name Last Name
Child Adult
   
Languages other than English
written oral
written oral
written oral
   
PROFESSIONAL INFORMATION

 

Employer Occupation City

Work Phone: Pager #:
E-mail Address:
   
EDUCATION
   

School Attending Attended
City State

Highest Grade Level:

 
School type Other
If College graduate or business school: Degree/certificate
Date received/expected Graduation Date Anticipated Date
 

Special training:

Certifications::
 
SPECIAL INTEREST/HOBBIES/SPORTS/ENTERTAINMENT (check all that apply)
   
Ministries  
C. G. Wooding Nurses Interested Active
Catering Interested Active
Children's Choir Interested Active
Christian Education Interested Active
Dance Ministry Interested Active
Designated Friends Interested Active
Economic Empowerment Interested Active
Faith In Action Interested Active
FBC Resourse Center (Bookstore) Interested Active
Hospitality Ministry Interested Active
J.A.M. Interested Active
Jr. JAM Interested Active
Jr. Ushers Board Interested Active
LoveForce: HIV/AIDS Interested Active
Media Ministry Interested Active
Men's Fellowship Interested Active
Pastor's Aide Interested Active
Praise Ensemble Interested Active
Prayer Posse Interested Active
Scholarship Ministry Interested Active
Senior Fellowship Interested Active
Senior Missionaries Interested Active
Senior Usher Board Interested Active
Single Parents Interested Active
Summer Renewal (VBS) Interested Active
Sunday School Interested Active
Tape Ministry Interested Active
Teen Choir Interested Active
TIPS Traffic, Info, Park, Safety Interested Active
Transportation Interested Active
VOP Interested Active
Women's Auxiliary Interested Active
Women's Retreat Interested Active
Youth Ministry Board Interested Active
   
Net Care Group
HBCU Graduates
   
Other Opportunities to Serve
First Baptist CDC
Harvest of Hope
Renaissance Credit Union
   
Hobbies  
Ceramics / Sculpting
Reading
Painting
Photography
Other
   
Sports  
Baseball
Basketball
Bike Riding
Bowling
Football
Golf
Other
   
Entertainment  
Theater
Ballet
Museums
Movies
Concerts
Opera
Other
   
   
Questions
Would you like to be subscribed to Pastor’s Corner and receive email broadcasts for Pastor Soaries? Yes No
Do you know anyone who may be interested in the Free STRIVE employment training program? Yes No
Are you interested in being a foster parent or foster parent volunteer? Yes No
   

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