House of Prayer International Membership Registration Form

Surname:

First Name:

Sex:

M F

Marital Status:

S M D W

Birthday (Day & Month):

Wedding Anniversary:

Age - Under 18:

Age - 19-24:

Age - 25 & Above:

Tel:

Address:

Landmark:

Email:

Can We Pay You A Visit?

If Yes, Where?

Please, Provide Address if different from Above:

How do you Prefer we Reach You:

Text Call Email WhatsApp

Have u been Baptized by Immersion?

Yes No

If Yes, When:

If No, Would you like to be baptized in the next few weeks?

CHIESA EVANGELICA PENTECOSTE