Membership – WORD OF LIFE INTERNATIONAL CHURCH

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Name

First Last

Enter Email Confirm Email

Phone

Date of Birth

Occupation

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Marital Status

Spouse's Name

First Last

Spouse's Email

Enter Email Confirm Email

Spouse's Occupation / Profession

Spouse's Phone

Do you have any children?

How many children do you have?

Child #1 Name

First Date of Birth

Child #2 Name

First Date of Birth

Child #3 Name

First Date of Birth

Child #4 Name

First Date of Birth

Child #5 Name

First Date of Birth

Are you baptised?

Yes, I am baptised

No, I am not baptised

Baptism Date

Baptism Place

When did you become a member of WOLICOG?

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