Fairview Missionary Baptist Church

FBC Membership Registration 2024 (For Fairview Members Only)

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In an effort to maintain and update our church membership files, we ask that you would complete the form below. This information will be maintained by the church office and will be for official use only.

To complete the registration process, please complete all applicable blanks, scroll to the bottom, confirm and submit. You should receive a confirmation email if the form is processed.

Registrant's Name (Person completing the Form) *


First Name	Last Name

Is this a name change? If so, please list other names below.

Address (If P. O. Box, please list finding address on second line) *


Address

Address Line 2

City	State	Zip Code

Primary Phone Number *

Phone Number

Phone Type *

Select one

Home
Cell
Work

Secondary Phone Number

Phone Number

Phone Type

Select one

Home
Cell
Work

Primary Email Address *

Email Address

Secondary Email Address (if applicable)

Email Address

Date of Birth *

Click in box to select date

Date Joined Fairview

Click in box to select date

SPOUSE INFORMATION (If Applicable)

Spouse Name


First Name	Last Name

Other Names Used?? Please list below

Address (if different from Registrant)


Address

Address Line 2

City	State	Zip Code

Primary Phone Number

Phone Number

Phone Type

Select one

Home
Cell
Work

Secondary Phone Number

Phone Number

Phone Type

Select one

Home
Cell
Work

Is spouse a member of Fairview?

Select one

Yes
No
Attends but is not a member

EMERGENCY CONTACT INFORMATION *


First Name	Last Name

Address


Address

Address Line 2

City	State	Zip Code

Primary Phone Number *

Phone Number

Secondary Phone Number

Phone Number

Relationship

PLEASE COMPLETE INFORMATION BELOW FOR ALL HOUSEHOLD MEMBERS, 18 AND UNDER

Name


First Name	Last Name

Date of Birth

Click in box to select date

Relationship

Fairview Member?

Select from list

Name


First Name	Last Name

Date of Birth

Click in box to select date

Relationship

Fairview Member?

Select one

Yes
No
Attends but is not a member

Name


First Name	Last Name

Date of Birth

Click in box to select date

Relationship

Fairview Member?

Select one

Yes
No
Attends but not a member

Name


First Name	Last Name

Date of Birth

Click in box to select date

Relationship

Fairview Member?

Select one

Yes
No
Attends but not a member

Name


First Name	Last Name

Date of Birth

Click in box to select date

Relationship

Fairview Member?

Select one

Yes
No
Attends but not a member

Name


First Name	Last Name

Date of Birth

Click in box to select date

Relationship

Fairview Member?

Select one

Yes
No
Attends but not a member

Does your family attend Sunday School? *

Select one

Yes
No

* required