- Step 1 of 5Date of Service Attended: *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Service Time Attend: *Sunday ( 8:00 AM )Sunday ( 11:00 AM )Thursday ( 7:15 PM )Are you a first time visitor? *YesNoYour decision today ( Please check one or more )Church MembershipReceive Christ As Your SaviorInfilling of Holy SpiritNextYour InformationPrefixMr.Mrs.Miss.NameFirstLastSuffixJr.Sr.EmailHome PhoneCell PhoneTO OPT IN TO RECIEVE TEXT MESSAGE FROM LPH, TYPE IN 71411AddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePreviousNextChurch MembershipPlease complete the following, if you selected church membership. Please select the next button to proceed if you did not select church membership.GenderMaleFemaleBirthdayMM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Martial StatusSingleMarriedDivorcedWidowedSpouse's NameIf your spouse desires membership, he / she must complete a separate form.Wedding Anniversary DateMM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Former Church NameChildren living at home who will be attending churchChild 1 NameFirstLastChild 1 BirthdayMM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Child 1 GenderMaleFemaleChild 2 NameFirstLastChild 2 BirthdayMM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Child 2 GenderMaleFemaleChild 3 Name FirstLastChild 3 BirthdayMM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Child 3 GenderMaleFemaleChild 4 NameFirstLastChild 4 BirthdayMM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Child 4 GenderMaleFemalePreviousNextVolunteerCheck the area in which you would like to volunteer:Office / Mail VolunteerGreeterUsherWomen of FaithChoir / Music DepartmentBus MinistrySunday SchoolYouth ( Teenagers )Youth ( Nursery )Youth ( Children's Church )Pastor's HelpersBook & Tape MinistrySoul Winning / OutreachMen's FellowshipWomen's FellowshipCounselor / Alter WorkerMarried CouplesSingles Ministry Building / Church MaintenanceTV / Radio MinistrySpecial EventsO.A.S.I.S. ( Older Adults Still In Service )Audio / SoundExtended Hands MinistryPreviousNextMembership PledgeI understand that membership in a church is meaningless, unless, the individual has made a decision to accept Christ as Savior. I hereby certify that I have made that decision regarding my responsibility as a member of LPH Family. I hereby pledge that I am willing to be instructed regarding the doctrine of the Church. I further hereby pledge that I, to the best of my ability, will seek to live and think in accordance with those doctrines and responsibilities.Signature Clear Signature" Date PhoneSubmit
