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First Name:

Last Name:

Gender: Yes No

Birth Date: (e.g. MM/DD/YYYY)

Address:

City:

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Primary Phone Number:

Secondary Phone Number:

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E-mail Address: (e.g. Joe@abc123.com)

Are you a member of The Glory Center? Yes No

Have you received salvation? Yes No

Ministry Interests (Check all that apply)

Fine Arts Liturgical Dance Remnant Hip Hop Dance Mime Drama Praise & Worship Team Choir Band

Education GCI Bible Institute New Discipleship SELAH Wellness Glory Center Christian Bookstore

Ministries of Help Ushers Greeters Intercessory Prayer Team Security Armor Bearers Transportation Harvest House Culinary Hospitality Custodial Volunteers

Communications Audio/Visual Advertising/Marketing Glory Point of View G-Unit Evangelism

Administration Announcers Finance Historian

Life Kingdom Kids (0-6yrs) Youth for Christ (7-11 yrs) Ignite (12-18 yrs) Joshua's TROOP (College/Young Adult) Rose of Sharon Women Men's Ministry Singles 2 Become One Marriage Seniors