Next Steps

Welcome to Antioch Christian Fellowship
Please complete the Next Steps form so we may get to know you better.

Date

Name

Date of Birth

Gender

Please select all that apply.

Male Female

Address

Apartment Number

This address will receive a confirmation email

Mobile

Marital Status

Please select one option.

Single Married Divorced Widowed

Spouse's Name

Gender

Please select all that apply.

Male Female

Date of Birth

Mobile

This address will receive a confirmation email

Child's Name

Child's Date of Birth

Child's Name

Child's Date of Birth

Child's Name

Child's Date of Birth

Child's Name

Child's Date of Birth

Household | Name(s) and Date(s) of Birth of Child(ren)

Membership Type. Please check all that apply.

Please select all that apply.

New Member V-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?

Please select one option.

Yes No

Baptized Believer?

Please select one option.

Yes No

Do you have an immediate need for prayer?

What Areas of Ministry are you interested in?

What attracted you to Antioch Christian Fellowship

How did you hear about us?

Please select one option.

Referral/ Walk In Social Media Website

For Office Use Only

Text Messaging Consent

Do You Wish To Receive Text Messages?

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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.

Picture File Number

Intake Personnel

Please select one option.

Online/Self Brandon Carter Latrecia Carter Vincent Ebron Sharon Ebron Tony Frierson Latresha Stewart Terrion Talley Devin Talley

Description

Welcome to Antioch Christian Fellowship
Please complete the Next Steps form so we may get to know you better.

Next Steps

Description

Please Fix the Following