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Membership Interest Form
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Membership Interest Form
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Work Entry
Thank you for your interest in Second!
We'd like to learn a little about you.
First Name
First Name is required.
Last Name
Last Name is required.
Mobile Phone
Mobile Phone is required.
Give your consent to receive SMS messages by simply checking the box.
Birthdate
Jan
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1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Birthdate cannot be a future date.
Gender
Male
Female
Show Spouse
Address
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Marital Status
Married
Single
Divorced
Widowed
Domestic Partnership
Unknown
Remarried
Separated
What drew you to Second? How did you become interested in this church?
Worship
Music and Fine Arts
Mission and Community Outreach
Children's Programs
Preschool
Youth Programs
Adult Programs
Other
What drew you to Second? How did you become interested in this church? is required.
We'd love to know more about your family (names and ages of family members who might be joining Second with you).
What is your former church (if any)?
Do you have family or friends at Second? If so, please tell us their names.
Have you been baptized?
Yes
No
Not sure
Have you been baptized? is required.
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