New Member Form FULL NAME * First Name Last Name BEST CONTACT NUMBER (###) ### #### MAILING ADDRESS Address 1 Address 2 City State/Province Zip/Postal Code Country EMAIL ADDRESS * DATE OF BIRTH * NAME OF FAMILY MEMBER AT THE ROOM CHURCH First Name Last Name I IDENTIFY AS... WOMAN MAN TRANSGENDER NON-BINARY/NON-CONFORMING PREFER NOT TO RESPOND HAVE YOU BEEN BAPTIZED AS A BELIEVER IN JESUS Yes No IF UNDER 18, PARENT/GUARDIAN NAME AND BEST CONTACT NUMBER EMERGENCY CONTACT PERSON Name and Contact Number MARITAL STATUS Thank you for submitting the new member form!