Membership Application

Your name *

Last name

Email address *

Phone number *

Phone type

MobileHomeWorkOther

Address *

HomeWorkOther

Country

Country

Street address

Apt/unit/box (optional)

City

State

Postal code

Gender *

Select…MaleFemale

Birthday

Marital status

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Household members

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School

Select…ProvidencePeabody CharterProvidenceProvidenceSanta Barbara High SchoolSan Marcos High SchoolDos Pueblos High SchoolWestmont CollegeUCSBSanta Barbara City College

Occupation

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How did you discover CPC? *

Have you ever been baptized? *

Select…YesNo

Are you currently a member of a church? *

Yes

No

Please tell us why you would like to become a member of Christ Presbyterian Church. *

Please tell us why you believe that you are personally in need of salvation. *

Please tell us why you believe you will be saved. *

Please tell us more about how you became a follower of Jesus Christ? *

Would you be willing to share your story on a Sunday if asked?

Yes

No

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