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First Name *
Middle Name *
Last Name *
Date Of Birth *
Address 1 *
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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,
and request my application be considered for membership. in FULL
I Understand the submission of this online form counts as my physical signature.