Membership Sign-Up Fill out this brief form to become a member of Harvest! MEMBER INFORMATION Name* First MI Last Gender*MaleFemaleDate of Birth* Date Format: MM slash DD slash YYYY Marital Status*SingleMarriedDivorcedWidow/WidowerAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Cell Number*Alternate NumberEmail* Emergency Contact Name* First Last Emergency Contact Phone Number*How did you hear about Harvest Life Church?*Harvest Life MemberFriendDriving ByWebsiteInvitation CardSocial Media (Facebook and YouTube)Door HangerTelevisionSPOUSE INFORMATION Spouse Name First MI Last Please check one of the following. My spouse is already a member of Harvest Life. My spouse is not a member of Harvest Life. My spouse is joining Harvest Life today! (Please complete the information below.) Date of Birth Date Format: MM slash DD slash YYYY Cell NumberAlternate NumberEmail Please provide the following information about your child(ren) age 17 and under.Click the plus sign to the right of the row to add additional children's names.Child's NameDate of BirthGender (Male or Female) CHILDREN'S INFORMATION Please provide information for your children ages 0-18. Name First Middle Last Date of Birth Date Format: MM slash DD slash YYYY GenderMaleFemaleName First Middle Last Date of Birth Date Format: MM slash DD slash YYYY GenderMaleFemaleName First Middle Last Date of Birth Date Format: MM slash DD slash YYYY GenderMaleFemaleName First Middle Last Date of Birth Date Format: MM slash DD slash YYYY GenderMaleFemaleName First Middle Last Date of Birth Date Format: MM slash DD slash YYYY GenderMaleFemaleName First Middle Last Date of Birth Date Format: MM slash DD slash YYYY GenderMaleFemaleGET CONNECTED Have you ever been baptized?YesNoText Club*Get connected and stay in the know by joining our Harvest Life Text Club! You'll receive special updates, reminders and more! Simply reply "Yes" when you receive the invitation text.Add me to the Text Club!Not at this timeMembership Email List: As a member of Harvest Life, you will be added to our email list to receive important church correspondence. Please click on "Yes, subscribe me to this list" when you receive the confirmation email.
