Shalom Missionary Baptist Church
New Member Personal Data Information
Please complete all information requested.
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Name:
Email:
Comment:
Email Address
*
First Name
Middle Inital
Last Name
Gender
Male
Female
Birthday
Month
/
Day
Include year
Marital Status
Single
Married
Select One
Wedding Date
MM/DD/YYYY
Candidate for Baptism?
Yes
No
Occupation
What are your skill sets?
Spouses Name
Is Spouse a Christian?
Yes
No
List children under 18
Children name, age & birthday
Image URL
How did you hear about Shalom?
Invited
Website
Facebook (social media)
