1700 Napa Valley Drive - Little Rock, AR, 72212
Office (501) 225-9231
Ministries
Mission and Outreach
Asbury Christian Child Development Center
Children’s Ministry
Student Ministries
Young Adult Ministry
Adult Ministry
Music Ministries
Member Resources
Donate
Ministry Teams
Forms
Directory
Events / Media
Sermon Audio/Visual
Calendar
Member Resources
Donate
Ministry Teams
Administrative and Office Ministries
Adult Discipleship Ministries
Children’s Ministry Team
Congregational Care Ministries
Hospitality Ministries
Missions and Outreach Ministries
Student and Young Adult Ministries
Worship and Arts Ministry
Forms
A Covenant For Ministry
New Membership Information
Ministry Reference Guide
Baptism Information Form
Directory
Archives
Search our Website
Search for:
Upcoming Events
Forms
New Membership Information
New Membership Information
We are so glad you have chosen to make Asbury your church home! Please take a few moments to fill out this information so we can have it for our records. This information will be kept in complete confidence.
First Name
*
Middle Name
*
Last Name
*
Date Joined
*
Title
Mr.
Mrs.
Ms.
Dr.
Rev.
Suffix
Jr.
Sr.
I
II
III
IV
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Home Phone
(***)***-****
Cell Phone
(***)***-****
Work Phone
(***)***-****
Emergency Contact (Name & Relation):
Phone of Emergency Contact
Primary Email Address
*
Alternate Email Address
Birthday
*
mm/dd/yyyy
Baptism Date
mm/dd/yyyy
Place of employment
Occupation
If the new member is a child, list parents' names
Is there a former church?
Yes
No
Denomination?
*
UMC
Other
Can we contact your former church?
*
Yes
No
We would contact your former church to request transfer of membership, and any other pertinent information for our membership rolls.
Name of former church
*
Address of former church
Street Address
City
State / Province / Region
ZIP / Postal Code
Was this the former church of all members of your household?
*
Yes
No
List any other family members joining from this former church
Name
Relation
Add more members by clicking the "+" icon to the right of the 'Relation' field.
Marital Status
*
Single
Married
Widowed
Divorced
Anniversary Date
mm/dd/yyyy
Name of Spouse
First Name
Middle Name
Last Name
Title
Mr.
Mrs.
Ms.
Dr.
Rev.
Suffix
Jr.
Sr.
I
II
III
IV
Cell Phone
(***)***-****
Work Phone
(***)***-****
Emergency Contact (Name & Relation):
Phone of Emergency Contact
Primary Email Address
Alternate Email Address
Birthday
*
mm/dd/yyyy
Baptism Date
mm/dd/yyyy
Place of employment
Occupation
Children?
*
Yes
No
Child 1
First Name
Middle Name
Last Name
Title
Mr.
Mrs.
Ms.
Dr.
Rev.
Suffix
Jr.
Sr.
I
II
III
IV
Birthday
mm/dd/yyyy
Baptism Date
mm/dd/yyyy
Confirmed?
Yes
No
Child 2
First Name
Middle Name
Last Name
Title
Mr.
Mrs.
Ms.
Dr.
Rev.
Suffix
Jr.
Sr.
I
II
III
IV
Birthday
mm/dd/yyyy
Baptism Date
mm/dd/yyyy
Confirmed?
Yes
No
Child 3
First Name
Middle Name
Last Name
Title
Mr.
Mrs.
Ms.
Dr.
Rev.
Suffix
Jr.
Sr.
I
II
III
IV
Birthday
mm/dd/yyyy
Baptism Date
mm/dd/yyyy
Confirmed?
Yes
No
Child 4
First Name
Middle Name
Last Name
Title
Mr.
Mrs.
Ms.
Dr.
Rev.
Suffix
Jr.
Sr.
I
II
III
IV
Birthday
mm/dd/yyyy
Baptism Date
mm/dd/yyyy
Confirmed?
Yes
No
Child 5
First Name
Middle Name
Last Name
Title
Mr.
Mrs.
Ms.
Dr.
Rev.
Suffix
Jr.
Sr.
I
II
III
IV
Birthday
mm/dd/yyyy
Baptism Date
mm/dd/yyyy
Confirmed?
Yes
No
Child 6
First Name
Middle Name
Last Name
Title
Mr.
Mrs.
Ms.
Dr.
Rev.
Suffix
Jr.
Sr.
I
II
III
IV
Birthday
mm/dd/yyyy
Baptism Date
mm/dd/yyyy
Confirmed?
Yes
No
Child 7
First Name
Middle Name
Last Name
Title
Mr.
Mrs.
Ms.
Dr.
Rev.
Suffix
Jr.
Sr.
I
II
III
IV
Birthday
mm/dd/yyyy
Baptism Date
mm/dd/yyyy
Confirmed?
Yes
No
Comments
This field is for validation purposes and should be left unchanged.