Philadelphia Presbyterian Church of Mint Hill, NC
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PPC New Member Information Form
New Member Information Form:
1.
* Date:
2.
* Name (1):
3.
Preferred Name:
4.
*

Birthdate:

5.

Date Baptized:

6.
Cell Phone:
7.
Email:
8.
Occupation:
9.
Name of Business/Address/Phone:
10.
* Please Check One: (1 required)
Yes, I would like to join PPC. Not at this time but add to mailing list I would like a pastor to contact me.
11.
* Joining by: (1 required)
Proffession of Faith Reaffirmation of Faith
Transfer
12.
Date I would like to join PPC:
13.
Current Church Membership (give complete address if out of town):
14.
Offices and responsibilities held in former churches:
15.
Hobbies and Interest:
16.
Name (2):
17.
Preferred Name:
18.
Birthdate:
19.
Date Baptized:
20.
Cell Phone:
21.
Email:
22.
Occupation:
23.
Name of Business/Address/Phone:
24.
* Please Check One: (1 required)
Yes, I would like to join Not at this time but add me to the mailing list I would like a pastor to contact me
25.
* Joining by: (1 required)
Proffession of Faith Reaffirmation of Faith Transfer
26.
Date I would like to join PPC:
27.
Current Church Membership (give complete address if out of town):
28.
Hobbies and Interest:
29.
* Home Address:
30.
* City/ State/ Zip:
31.
* Home Phone:
32.
* Marital Status (1 required)
Married Divorced Widowed Single
33.
Anniversary Date:
34.
Emergency Contact/Phone:
35.
What functions have you attended at PPC?
36.
How did you hear about Philadelphia Church?
37.
1. Full Name of Child Living at Home:
38.
Preferred Name:
39.
Birth Date:
40.

School/Grade:

41.
Date Baptized/Confirmed:
42.
2.  Full Name of Child Living at Home:
43.
Preferred Name:
44.
Birth Date:
45.
School/Grade:
46.
Date Baptized/Confirmed:
47.
3.  Full Name of Child Living at Home:
48.
Preferred Name:
49.
Birth Date:
50.
School/Grade:
51.
Date Baptized/Confirmed:
52.

Additional Comments:

53.

OFFICE USE ONLY:
District Number:
District Officer:
Member Number:
Envelope Number:
Date Joining:

Type in the text that you see above:
  

Philadelphia Presbyterian Church
11501 Bain School Road
Mint Hill, NC 28227
Phone: 704-545-6172
lcumminsppc@bellsouth.net

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