__Mr. __Mrs.
__Miss___________________________Date_____________
Address_______________________________________________________
City_____________________________State_____Zip Code_____________
Phone (Home)_____________ ______(Mobile)_______________________
E-Mail________________________________________________________
Are you a member of this church?
___YES___NO
If Yes how long have you been a member
___less than 1 year ___1-4 years ___5-9 years ___9-13 years ___14-18 years ___19 or more years
Do you consider this to be your church home?
___YES ___NO
On average, how many times per month do you attend worship service?
___1-2 times per month ___2-3 times per month ___Every Sunday
Approximately how many miles do you live from the church?
___0-5 miles ___6-10 miles ___10-20 miles ___20+ miles
Do you consider yourself a local resident? (live within 15 miles of the church)
___YES ___NO
What town or city do you live in or near?
_________________________________
What is your employment status?
___Retired ___Self Employed ___Employed
Are you a tither (do you give 10% of your earnings to the church)?
___YES ___NO
If not, how much would you say you contribute to the church?
___1-3% ___4-6% ___7-9%
What are you? ___MALE ___FEMALE
What age group are you in?
___15-25 ___25-35 ___35-50 ___50-65 ___65 and above
Are you currently active in ministry of the church?
___YES ___NO
If yes, What ministry or ministries are you currently working?
___________________________________________
___________________________________________
If no, are you interested in participating in a ministry? What Ministry?
___YES ___NO
___________________________________________
___________________________________________
Membership Form – Rev 0
Are you a college student?
___YES ___NO
Do you use social media platforms (Facebook,Twitter, Instagram,Snapchat, etc…)?
___YES ___NO
What is your preferred method of communication?
___Phone ___Email ___Social Media ___Text ___Verbal ___Letter
How would you describe the quality of worship service?
___High Quality ___Moderate ___Low Quality
How likely would you recommend our church to others?
___Very Likely ___Somewhat likely ___Unlikely
Comment:
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Membership Form – Rev 0
