WILDWOOD

Membership Application
Wildwood Church
East Moline, IL



First Name:

Last Name:

Birthdate: Month Day Year

Marital Status

Spouse's Name

Anniversary Date: Month Day Year

Address

City

State Zip

Email Address

Home Phone Work Phone

Place of Employment

Describe how you came to trust Christ as Savior:


Describe the time you were baptized by immersion:


Where were you baptized by immersion?

Are you a member of another church?

(If yes, list Name and Address of the church:)
Approximately how long have you attended Wildwood?

Please list family members who live with you, their relationship to you and birthdates:
Name





Relationship






Birthdate






Please write a brief statement explaining the reasons you wish to become a member of Wildwood.

Please list any ministries in which you have been involved, such as teaching, music, elder/deacon/trustee, etc.
and/or how you would like to be involved at Wildwood.

Have you read the Wildwood Statement of Faith?
List any areas of question or disagreement with the Wildwood Statement of Faith: