MEMBERSHIP APPLICATION

CONTACT INFORMATION

NAME

EMAIL

BIRTHDATE (mo/day)

ADDRESS

CITY

STATE

ZIP CODE

HOME PHONE:

CELL PHONE:

WORK PHONE:

MARITAL STATUS (SELECT)

- None -SINGLEMARRIEDPARTNER

FULL NAME OF SPOUSE/PARTNER

ANNIVERSARY

OCCUPATION (or previous occupation if retired)

Child #1

NAME

AGE

DO YOU HAVE ANOTHER CHILD? (SELECT)

- None -YESNO

Child #2

NAME

AGE

DO YOU HAVE ANOTHER CHILD? (SELECT)

- None -YESNO

Child #3

NAME

AGE

DO YOU HAVE ANOTHER CHILD? (SELECT)

- None -YESNO

Child #4

NAME

AGE

DO YOU HAVE ANOTHER CHILD? (SELECT)

- None -YESNO

Child #5

NAME

AGE

Do you have a talent or expertise you would enjoy sharing with the Church?

Volunteer Teams (Please check any you might be interested in joining)

Choir

Chaplains' Program

Helping Hands

Prayer/Healing Ministry

PowerPoint

Ushers/Greeters

Sound

Lights

Hospitality

Youth & Family

Music/Singer/Instr.

Publicity

Office Support

Computer/Website

Bookstore

Lending Library

Events

Gardening

Maintenance

Community Action

If you would like to join a book study group, please check the box(es) below:

Way of Mastery (weekly)

Spiritual Exploration (weekly)

A Course of Love (weekly)

Matt Kahn (bi-monthly)

Would you like information on how to support Unity in the Gold Country financially?

Would you like information on direct debit/credit support of Unity in the Gold Country?

I have an earnest interest in joining Unity in the Gold Country Family as a member. I plan on attending the orientation session that is required in order to become a member.

Any additional comments or information that you would like to provide:

Date

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