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My Next Step Today*: (check all that apply)
I want to accept Jesus Christ as my Savior.I would like to be baptized.I would like to become a member of Green Valley.I would like to talk to a ministry team member.
Today's Date:
Full Name*:
Name you go by:
Gender: MaleFemale
Marital Status: SingleEngagedMarried
Date of Birth:
Cell Phone:
Home Phone:
Email:
Permanent Address:
Temporary/College Address:
Occupation:
Place of Employment:
Choose one of the following: I have never been a member of a church before.I am currently a member of a church (list church below)I wasn't a member, but I formerly attended a church (list church below)
Church Name:
Have you been baptized by immersion?: yesno
Also living at my home: Please give name, DOB, grade, age and school attended by children (if applicable) and relationship to you.
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