Name  * 
Address  * 
Home #
Cell # or Alternate #
D.O.B.  * 
Your Email Address  * 
Emergency Contact Name  * 
Emergency Contact Telephone #  * 
Relationship  * 
Marital Status  * 
Wedding Anniversary Date  * 
Name of Spouse (if applicable)  * 
Number of Children  * 
Name of Children and D.O. B. (if applicable)  * 
Where were you born? Where were your raised?
Occupation  * 
Employer Name  * 
Business Address  * 
Educational level  * 
Professional licenses  * 
How did you hear about Rehoboth Open Bible Church?  * 
Date of Salvation  * 
Date of Baptism (Water)  * 
Date of Baptism (Holy Spirit)  * 
Describe your devotional time
Do you know your spiritual gift(s)?  * 
If so, what is it?  * 
Do you have a prayer partner?  * 
Do you understand the purpose of tithing?  * 
Are you faithful in your tithing?  * 
What ministry(s) are you interested in?  * 
Describe your comfort level in witnessing to others (scale from 1 - 10 – 10 being the highest)  * 
What are some areas in your Christian faith you would like to improve? (for example, fasting, tithing, bible study, prayer, application of the Word) * 
Do you have a disability that requires an special accommodations in church? (Large text bible vision impairment, sermons on CD-hearing impairment, sign language interpreter, etc) * 
Do you have any questions/concerns that you would like to discuss during the membership interview? * 
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