CPC Members & Friends
Partner Information
Your Name
*
First Name
Last Name
Your Birthday
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Your Email
example@example.com
Your Cell Phone Number
Format: (000) 000-0000.
Partner’s Name
First Name
Last Name
Partner Birthday
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Partner Email
example@example.com
Partner Cell Phone Number
Format: (000) 000-0000.
Anniversary
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Children
Child 1
First Name
Last Name
Birthday 1
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number 1
Format: (000) 000-0000.
Child 2
First Name
Last Name
Birthday 2
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number 2
Format: (000) 000-0000.
Child 3
First Name
Last Name
Birthday 3
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number 3
Format: (000) 000-0000.
Child 4
First Name
Last Name
Birthday 4
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number 4
Format: (000) 000-0000.
Church Information
In what year did you and family join CPC?
Leave blank if not a member
Elder Service CPC and elsewhere
Have you ever served as an Elder?
Deacon Service CPC and elsewhere
Have you ever served as a Deacon?
Ministry Interest 1
Music
Visitation
Worship
Youth
Adult Education
Prayer
Mission
Property
Administration
Finance
Hospitality
Education
Media
Ministry Interest 2
Music
Visitation
Worship
Youth
Adult Education
Prayer
Mission
Property
Administration
Finance
Hospitality
Education
Media
Ministry Interest 3
Music
Visitation
Worship
Youth
Adult Education
Prayer
Mission
Property
Administration
Finance
Hospitality
Education
Media
Other
Anything else useful to know?
Submit
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