Mount Zion Albany GA - MtZionAlb New Member

First / Middle / Last Name

Date of Birth (MM / DD/ YYYY)

Gender
Female
Male

If New Member is a minor please list parent/guardian name:

If guardian / parent is different than child please list it

Home Phone Number

Home Unlisted
Yes
No

Mobile #

Mobile Unlisted
Yes
No

Business #

Address 1

Address 2 (Enter N/A)

County

City

State

Zip/Postal Code

Marital Status
Single
Married
Divorced
Widowed

I am joining Mt Zion Albany by
Baptism
Christian Experience
Watch Care
Restoration

If joining by Watch Care, have you been baptized?
Yes
No

Email Address

Head of Household:
Yes
No

Occupation

If Baptized other than at Mt. Zion, please list name of church

Date Baptized:

City/State

Former Church Affiliation

City / State

Emergency Contact #

Emergency contact Name

Are there other members in your family (household) that are members of Mt. Zion?
Yes
No

If yes, please list their name(s) and relationship to you (including those joining today)

Please list any special needs:

I agree this information is correct
Yes
No

Are You Coming to Us
Online
In-person

PLEASE EMAIL A HEADSHOT to mtzion.info@mtzionofalbany.org. Thank You!
Yes

Mount Zion New Member