Church Membership Application Form

Thanks for your interest in membership at Life Church 180 Assembly of God! Please fill out the form below in its entirety. If you have not yet completed the Membership Class Lessons either online or in person please do that first!

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

First Name *

Middle Name *

Last Name *

Date Of Birth *

Address 1 *

Address 2

City *

Zip / Post Code *

Home Phone

Cell Phone *

Work/Other Phone

Email *

Spouse First Name

Spouse Middle Name

Spouse Last Name

Spouse Date Of Birth

Date of Wedding Anniversary

How long have you been attending Life Church 180 Assembly of God? *

Child 1 - Full Name

Child 1 - Date of Birth

Child 2 - Full Name

Child 2 - Date Of Birth

Child 3 - Full Name

Child 3 - Date Of Birth

Child 4 - Full Name

Child 4 - Date Of Birth

Child 5 - Full Name

Child 5 - Date of Birth

If you have accepted Jesus Christ as your personal Lord and Savior, check this box.

If your spouse has accepted Jesus Christ as their personal Lord and Savior, check this box.

If you have been baptized by immersion in water, check this box.

If your spouse has been baptized by immersion in water, check this box.

If you will support Life Church 180 Assembly of God with tithes and offerings according to the Hoy Scriptures, check this box.

If you will be faithful in attendance to worship services, bible studies, annual business meetings and any special business meetings, check this box.

If you agree with the 16 Fundamental Truths of the Assembly of God, check this box.

If you beleive in all the Bible and regard it as the rules of faith and practice in your daily life, check this box.

If you agree with the vision and mission of Life Church 180 Assembly of God, check this box.

Please briefly share a testimony of your Spiritual journey.

COVENANT OF MEMBERSHIP

I believe that the Holy Scriptures are the revealed will of God, and that they are the foundation of my faith and life as a follower of the Lord Jesus Christ.

I believe that in becoming a member of Life Church 180 Assembly of God, I am fulfilling the standard of the New Testament which are summarized in Ephesians 4:3-16.

I hereby pledge to serve Christ in and through His church and will faithfully support Life Church 180 Assembly of God by the grace of God.

I have completed the Membership Class lessons, either online or in person, in FULL and request my application be considered for membership.

I Understand the submission of this online form counts as my physical signature.