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Welcome to

KINGDOM IMPACT

"OUR HOME IS YOUR HOME"

MEMBERS APPLICATION

Please ensure that all questions are answered to the best of your knowledge.

First Name *

Last Name *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Home Phone

Cell Phone

Email Address

Are You Born Again?YesNo

If yes, for how long?

Were you baptized in Water?YesNo

If yes, for how long?

If No, Do you plan to get baptized?YesNo

If Yes, When?

Would you like counseling?YesNo

Are You Filled with the Holy Spirit?

What is your spiritual affiliation?

Were you a member at a previous church?YesNo

Why did you leave?

Would you like to meet with one of our Pastors?YesNo

What area of the Ministry is your passion?

Tell us what special gifts or talents you thrive in, so we can properly cater to your needs:

Are you attending with family members?YesNo

What is their name(s)?

Give two references:

First Name

Last Name

First Name

Last Name

Phone: (437) 829-8855
Email: thekingdomimpactcentre@gmail.com

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