* indicates required fields.

Today's Date: (mm/dd/yyyy)
*First Name, MI, Last Name:    
Gender:
Marital Status:
Head of Household: YesNo
Date of Birth: mm/dd/yyyy
State of Birth:
Home Address:
City
State:
Zip:
Home Phone:
Work Phone:
Mobile Phone:
Primary Email Address:
Secondary Email Address:
Wedding Anniversary: mm/dd
Date Joined: mm/dd/yyyy
Date Fellowshipped: mm/dd/yyyy
Joined Shiloh via: Candidate for Baptism  
Letter
Christian Experience
Watch care

Church Affiliation:

Pastor:

Family Ministry Tribe:
Envelope/Member Number:
Deacon(s): 

Deaconess(es):
Family, Friends and Children 
that attend the church:
(if child please provide age)		 Name:  
Relationship:
Age:
Member?: Yes No

Name:  
Relationship:
Age:
Member?: Yes No

Name:  
Relationship:
Age:
Member?: Yes No

Name:  
Relationship:
Age:
Member?: Yes No
Highest Level of Education Complete:
Major/Degree/Field of Study:
Home State and Town:
Position:
Occupation:
Specialization:
Gift or Talents?  (i.e. sing, 
technology, cook, teach, etc.):
Comments:

Check which ministry area you are currently involved with in the left hand box and which one you are interested in on the right hand box.

Involved Interested
OFFICERS
Deacons
Deaconesses
Treasurer
Trustees
Clerk
Financial Secretary
CHRISTIAN EDUCATION MINISTRY TEAM
Children's Ministry
Youth Director
Bookstore
Church School
College Ministry
Historian
Leadership Development and Training Ministry
Mid Day Bible Study
Non-Traditional Church School
Nursery
Scholarship
Tutorial Program
Vacation Bible School
COMMUNITY SERVICE MINISTRY
Athletics
Food Share
Harambee, Inc
Health Unit
Mentoring Ministry
Newsletter
Unshackled Jail & Prison Ministry
Shiloh of Alex. Federal Credit Union
Victim To Victory
EVANGELISM MINISTRY TEAM
Evangelism Team
Missionary Circle
Missions Committee
Prayer Ministry
FELLOWSHIP MINISTRY TEAM
Ever Ready Club
Flower Club
Hospitality
Men's Fellowship
New Member Class
New Member Orientation
Senior Citizen Ministry
Visitors, Ministry/ Willing Workers
Without Distraction (Singles)
Women's Ministry
Marriage Enrichment Ministry
WORSHIP MINISTRY TEAM
Combined Choir
Praise & Worship Ministry
Technicians for Christ
Ushers

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