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| Current Street Address |
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| Zip |
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| Home Phone |
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| Cell Phone |
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| Email |
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| Date of Birth |
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| Date of Baptism |
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| Current Church Membership |
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| Church City |
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| Church State |
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| Church Zip |
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| Reason for Transfer |
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| Marital Status |
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| Wedding Anniversary |
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| Spouse Name and Birthdate |
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| Children Names and Birthdates |
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| Ministry Needs (please select all that apply) |
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| if other please describe: |
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| What does ministry mean to you? |
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| What role does ministry play in your life? |
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| List your spiritual gifts/talents: |
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| List 3 Mt. Rubidoux Members who know you: |
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Describe your past involvement with
in-reach/outreach activities: |
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How will you serve the Kingdom of Christ
while at Mt. Rubidoux: |
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I am currently involved with or wish
to join the following ministries
(please check all that apply): |
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| if other/I wish to create one, please describe: |
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| How long have you been attending Mt. Rubidoux? |
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| Best way to contact me: |
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| Best time to contact me: |
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