Philadelphia Presbyterian Church Information Record

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Philadelphia Presbyterian Church Information Record Name (1): Occupation:

Business Phone:

Joining By:

Print Form

Date: Preferred Name:

Birth Date:

Please check:

Submit by E-mail

Cell Phone: Email(s)

Yes, I would like to join PPC Profession of Faith

Do you want an email reminder of upcoming events?

Yes No

I would like a pastor to contact me.

Reaffirmation of Faith

Transfer

Add me to the mailing list.

Date you would like to join:

Offices/Responsibilities in former Churches/Hobbies & Interest

Current Church Membership: (If out of town give complete address)

Name (2):

Preferred name:

Birth Date:

Occupation: Email(s)

Business Phone: Please check: Joining By Do you want an email reminder of upcoming events?

Cell Phone:

Yes, I would like to join PPC Profession of Faith Yes No

I would like a pastor to contact me.

Reaffirmation of Faith

Add me to the mailing list.

Transfer Date you would like to join:

Offices/Responsibilities in former Churches/Hobbies & Interest

Current Church Membership: (If out of town give complete address)

Home Address (street) Home Phone:

City/State/Zip

Marital Status (check):

Married

Divorced

Widowed

Single

Anniversary Date:

New Member Information Form - pg 2 Name(s) of Children Living at Home (full and preferred name): (1) Name/Middle/Last Birth Date:

Name Preferred: Grade/School:

Date Baptized:

(2) Name/Middle/Last Birth Date:

Name Preferred: Grade/School:

Date Baptized:

(3) Name/Middle/Last Birth Date:

Name Preferred: Grade/School:

Date Baptized:

(4) Name/Middle/Last Birth Date:

Name Preferred: Grade/School:

Date Baptized:

Emergency Contact (name/phone): What Functions have you attended at PPC? How did you hear about PPC?

Comments:

OFFICE USE ONLY: DISTRICT NUMBER: ___________________________

DISTRICT OFFICER: _______________________________

MEMBER NUMBER: ___________________________

SHEPHERDING PARTNER: __________________________

ENVELOPE NUMBER: __________________________

DATE JOINING: ___________________________________

Philadelphia Presbyterian Church 11501 Bain School Road Mint Hill, North Carolina 28227 (704) 545-6172 www.phildelphiachurch.org