Visiting & Membership

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  at Plymouth
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Prospective Member Form

Full legal name:
Preferred Email Address:
Any additional email address(es)?
What is your date of birth?
What is your gender	Male Female
How would you like your name tag to read?
What is your street address? (City, State, Zip)
Please provide your home phone number:
Please provide your work phone number:
Please provide your cell phone number:
If applicable, names, birth date and gender of spouse/life partner and children ages 18 and younger. (For children, please add grade in school.)
If you are listed on the membership roll of another church as an active member and would like your membership transferred to Plymouth, please give us information about that church so we might request a letter of transfer. (Church name, address, and city, state, Zip.)
Were you formerly a member of Plymouth Congregational Church?	Yes No
Were you baptized?	Yes No
If you were baptized, what year was that?
Were you confirmed?	Yes No
If you were confirmed, what year was that?
To help us in welcoming you, if you are willing please provide the following information:	Employed full time Self-employed Employed part time Student Full-time homemaker Unemployed Retired
If you are employed, what is your occupation and employer?
Please write a brief biographical sketch of yourself that we may include in the bulletin on the day you join the church. You may wish to include your profession, hobbies, interests, family and what draws you to our church.
Members of the Board of Membership will be contacting you regarding your response to the following question: Are there needs with which Plymouth Church can help you? Please list them.
Members of the Board of Membership will be contacting you regarding your response to the following question: Are there interests or abilities you wish to share with Plymouth Church? Please list them.