VCC Membership Application

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APPLICATION FOR MEMBERSHIP

Thank you for your interest in becoming a member of Victory Christian Center! Please use one application per person. Additional family members applying for membership must complete a separate application.

Campus *

Please attach picture of yourself here. * 🛈

First Name *

Preferred Name

Last Name *

Street Address *

City *

State *

Zip Code *

Home Phone Number *

Cell Phone Number

Email Address *

Employed By *

May we publish your phone number and email address in our directory?

Home Phone *

Yes

No

Cell Phone *

Yes

No

Email *

Yes

No

Date of Birth * +

Gender *

Male

Female

Marital Status *

Name of Spouse *

Spouse employed by

Spouse's Date of Birth +

Wedding Anniversary +

Do you have dependent children? *

Yes

No

Dependent Child's Name #1

Dependent #1 Date of Birth +

Dependent Child's Name #2

Dependent #2 Date of Birth +

Dependent Child's Name #3

Dependent #3 Date of Birth +

Dependent Child's Name #4

Dependent #4 Date of Birth +

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