Next Steps

Date

Name

Date of Birth

Gender

Male Female

Address and Apartment Number

This address will receive a confirmation email

Mobile

Marital Status

Spouse's Name

Gender Male Female

Date of Birth

Mobile

This address will receive a confirmation email

Child(ren) Full name and Date of Birth

Membership Type. Please check all that apply.

New Member E-Member New Believer: I just accepted Jesus as my savior Baptism Candidate: I want to be baptized

In your personal opinion, how can a person gain access to heaven?

Have you accepted the Gospel of Jesus Christ?

Yes No

Baptized Believer?

Yes No

Do you have an immediate need for prayer?

What Areas of Ministry are you interested in?

How did you hear about us?

Text Message Consent

Text Message Consent | Do you wish to receive text messages from Antioch?

Yes No

By selecting "Yes" above, I am consenting to receive SMS messages from Breeze regarding information and announcements for Antioch Christian Fellowship. I understand that message and data rates may apply and message frequency varies. I can opt out by responding STOP at any time. For support I can text HELP to 87447. Please review the Breeze Privacy Policy and Terms of Service available at breezechms.com for more details.

Antioch 101 (New Members Orientation)

Antioch 101 is our New Members Orientation that all of our new members are required to attend. This class allows you to learn more about who we are, what we believe and more. Register below by scanning the QR code today and learn more about us, our mission, vision, and core values.

The class is offered every 4th Saturday from 9am-12pm or online by clicking the link at Antioch 101. Be sure to scan the QR code today to register.

For Office Use Only

Picture File Name

Picture Taken

Yes No

Intake Personnel

Next Steps

Description

Please Fix the Following