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

Marital Status
Single
Married
Divorced
Widowed
Remarried

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