Please print and return the completed form to New Bethel at:
2508 Crest Street
Durham, North Carolina 27705
Fax: (919)286-7200
|
Rev. Leslie Stevens, Secretary |
Reverend Dr. Glenn R. Davis, Pastor |
John Daniels, Chairman Deacon Board |
|
Willie Hill, Finance Chairman |
Edgar L. Nunn, Treasurer |
|
CHURCH MEMBERSHIP AND DECISION RECORD
MR.
MRS.
MISS. ___________________________________ DATE ______________________
RESIDENCE ____________________________________________________________
PHONE ____________________________ CELL#: __________________________
MAILING ADDRESS: _____________________________________________________
BIRTHDATE: MONTH: _____________ DATE: ____________ YEAR: _____________
UNIVERSITY: _________________ CLASSIFICATION: 1__ 2__ 3__ 4__ GRAD__
EMAIL ADDRESS: _______________________________________________________
IM SCREEN NAME: AOL: ____________________ MSN: ______________________
YAHOO: __________________ OTHER: ____________________
NAME AND ADDRESS OF NEAREST KIN OTHER THAN ABOVE ADDRESS:
______________________________________________________________________
YOU ARE MAKING THE FOLLOWING COMMITMENT:
( ) ACCEPT CHRIST AS LORD AND SAVIOUR
( ) CHURCH MEMBERSHIP: BAPTISM ___ STATEMENT ___ LETTER ___
( ) FULL MEMBERSHIP
( ) WATCHCARE MEMBERSHIP
