Warsaw Assembly of God

First Name

Last Name

Phone Number

Email Address

Address

Birth Date

Date of Salvation

Baptized in Water?

Yes

No

Baptized in the Holy Spirit? (with the evidence of speaking in tongues)

Yes

No

Not sure

Previous Membership at (what Church)?

Are you applying for transfer of membership from another AG Church?

Yes

No

Have you requested by letter a transfer of membership from previous AG Church?

Yes

No

Have you completed the New Members Class?

Yes

No

Request for Membership