New Member Form

New Member Information

Mr./Ms./Mrs./Dr./The Rev

Mr. Ms. Mrs. Dr. The Rev.

Name

Middle or Maiden Name

Preferred Name

Address

Mailing or Alternate Address

Personal Profile

Birthday (year will not be shared)

Marital Status

This address will receive a confirmation email

Occupation

Home Phone

Alternate Phone

Preferred contact method

Email Home Phone Alternate Phone

Indicate whether Full Membership or Affiliate Membership

Full Affiliate

Basis for Full Membership

Select the one that applies for each person

Profession of Faith (never baptized) Reaffirmation of Faith (not currently a member of another church) Letter of Transfer

If you selected Letter of Transfer, please fill out the following information about your current church.

Church Name

Church Address

Tell us a little about yourself and your family!

The information below will help us introduce you to the congregation. Tell us about your hometown, community involvement, job, hobbies/interests, and areas of ministry at Rumple that you would like to know more about.

Have you been ordained as an Elder or Deacon in the Presbyterian Church USA? If so, what year and at which church? Please give the details and location.

Children

Please ask confirmed children to complete their own New Member Form.

1st Child

Last Name

First Name

Middle Name

Preferred Name

Birthday

School attending

Grade

Hobbies and Activities

Baptized? Yes No

2nd Child

Last Name

First Name

Middle Name

Preferred Name

Birthday

School attending

Grade

Hobbies and Activities

Baptized? Yes No

3rd Child

Last Name

First Name

Middle Name

Preferred Name

Birthday

School attending

Grade

Hobbies and Activities

Baptized? Yes No

4th Child

Last Name

First Name

Middle Name

Preferred Name

Birthday

School attending

Grade

Hobbies and Activities

Baptized? Yes No

5th Child

Last Name

First Name

Middle Name

Preferred Name

Birthday

School attending

Grade

Hobbies and Activities

Baptized? Yes No

New Member Form

Description

Please Fix the Following