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First Name *

Middle Name

Last Name *

Name you go by

Date of birth *

Gender *MaleFemale

Marital Status *

Occupation *

Email Address *

Would you like to receive our email newsletter?YesNo

Street Address *

Apartment, suite, etc

City *

State *

ZIP *

Primary phone *

Phone type *MobileHomeWork

Secondary Phone

Phone typeMobileHomeWork

Have you been baptized? *YesNo

Church (name & city) *

Are you currently a member of another church? *YesNo

Church (name & city) *

Are you an ordained officer in the PC (USA)?Ruling ElderDeacon

Are you joining with a spouse or significant other? *YesNo

Dependent children *

Member Information