HAEC Assimilation Form 1 HAEC 0077 updated 08/27/2012

HOPE AGLOW EMPOWERMENT CENTER

CONNECTION - ALTAR CARE - MEMBERSHIP

PERSONAL INFORMATION

Please Check Title: Dr. Pastor Minister Mr. Mrs. Ms. Miss Please Print Full Name (include middle initial):

Date of birth (mm/dd): (membership only)

Home Phone: Cell:

Email:

Current address:

City: State: ZIP Code:

Marital Status: Married Divorced Widowed Single Engaged

SPOUSE INFORMATION

Please Check Title: Dr. Pastor Minister Mr. Mrs. Ms. Miss Please Print Name (include middle initial):

Date of birth(mm/dd): (membership only)

Home Phone: Cell:

Email:

NAME AND AGE OF CHILDREN

Name: Age:

Name: Age:

Name: Age:

Name: Age:

PURPOSE FOR COMPLETING THIS FORM (CHECK ALL THAT APPLY)

First Time Guest Receive Salvation

Desire to become a member of Hope Aglow Empowerment Center Rededicated my life to Christ

Request More Information (check the ministry area from below) Need help studying the bible

I would like to volunteer (check all ministry interests from below)

Other (please explain)

Ministry Areas and Volunteer Opportunities

Men’s Ministry (Watchmen on the Wall) Women’s Ministry (Kingdom Women) Singles Ministry (Living in Full Empowerment – L.I.F.E) Senior Ministry (High Rollers) Young Adult Ministry (Righteously Empowered 2B Leaders) Youth Ministry (Crossfire) Maintenance Ministry Helping Hands Ministry Children’s Ministry* (for information only/not volunteering)

* Additional ministries available upon completion of membership orientation.

I desire a telephone call and/or email for:

Prayer Spiritual Guidance Church Activities Ministry Fellowships

How did you hear about us:

TV Flyer Shepard’s Guide Newspaper Post Card Internet Annual HAEC Picnic Community Event

HAEC Member (Please Print Name):

-- STOP HERE -- 2ND PAGE FOR NEW MEMBERS ORIENTATION

HAEC Assimilation Form 2 HAEC 0077 updated 08/27/2012

HOPE AGLOW EMPOWERMENT CENTER

CONNECTION - ALTAR CARE - MEMBERSHIP

OTHER PERSONAL INFORMATION (membership only)

Gender: Male Female Date Joined HAEC:

Wedding Anniversary Date: (month/day) Date Converted:

Family National Origin: Date Water Baptized:

Best time to contact you: Morning Mid-Day Evening Date Filled with Holy Spirit:

Career Field/Occupation: (self) (spouse)

TOP THREE AREAS OF VOLUNTEER INTEREST (membership only)

Anchor of Health Ministry Marketing Ministry Covenant Keepers Marriage Ministry Baptism Ministry Prison Ministry Ground Breakers/Prayer Ministry International Ministry Seeds of Empowerment Children’s Ministry Bookstore Ministry Information & Technology Transportation Ministry Membership Management Services Ministry Altar Care/Kingdom Builders Ministry Audio/Media Ministry Outreach/Evangelism Ministry Porter/Greeter Ministry Fine Arts Ministry (Choir, Musician, Dance)

OTHER HAEC FAMILY MEMBERS LIVING IN YOUR HOUSEHOLD

Member’s First & Last Name Relationship to You Member’s Date of Birth

EMERGENCY CONTACT (membership only)

Name of a relative not residing with you:

Address: Phone:

City: State: ZIP Code:

Relationship:

SIGNATURES (membership only)

I (we) desire to serve my Savior, Master and Lord Jesus Christ through the ministry of Hope Aglow Empowerment Center. To God be the glory in my life.

Signature of New Member: Date:

Signature of New Member: Date:

Signature of New Member: Date:

Signature of New Member: Date:

****** OFFICIAL USE ONLY ******* Follow-up information and comments (i.e. call, letter, text, in-person)

Date:

Date:

Date:

Date:

Date: