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Contact Info
684 West College St. Sun City, United States America, 064781.
(+55) 654 - 545 - 1235
info@zegen.com
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Member Application Form
Member Application Form
Prefix
Mr.
Mrs.
Ms.
Mx.
Miss
Dr.
Prof.
First Name
*
Middle Name
*
Last Name
*
Email Address
Phone
*
Date of Birth
*
Profession
Marital Status
*
Single
Married
Widow
Widower
Name of Spouse
Street Address
*
Apartment, suite, etc
*
City
Postal Code
*
Which Service Do You Attend
Holy Communion Service @ 7:00AM
First English Service @ 8:00AM
Second English Service @ 10:00AM
Are you baptised?
Yes
No
Are You a Communicant
Yes
No
Approximate Date You Joined ACK St. James Church Buruburu
Children's Names and Year of Birth (Under 18 years)
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Special Gifts/Talents
How would you wish to serve God at ACK ST James Buruburu?
Is there anyway that St. James Church can be of special help to you and your family?
Are you a registered member?
No
Yes
Membership Number
Are you or any of your household members disabled or homebound?
No
Yes
What topics would you like covered from the pulpit ministry?
Anything else you wish to comment on
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