Community Member Signup Form

This form is for you to request a Community Member Profile in one of our Community Websites.

You must be authorised to represent your church in this process.
You will also be required to agree with a 'Statement of belief' at the end of this form before you can submit it.


1. About You:

First name:	*
Last name:	*
Email:	*

Home Phone:
Work Phone:
Cell Phone:
(It would be helpful if you could please provide at least one personal contact number)


2. About Your Church

Church Name:	*
Principal Pastor(s):
Denomination:	*
Show Denomination on the website?:	* Yes No
Ethnicity:

Location where church services are held:
Address:	*

Town / City	*
Province:	*
Postal Code:	*
Country:	*

Church Telephone:

Church Website:
Church Facebook Page:
Church Twitter Handle:


3. Weekly Church Services:

Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
Attendance per Service:	*


4. Church Contact Details

Church Office Hours: (Leave any day blank where your office is closed)
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:

Details for Contact Form: (For church contact form - emails will NOT be shown)
Contact 1:	Email
Contact 2:	Email
Contact 3:	Email
Contact 4:	Email
Contact 5:	Email

We use Dropbox for sending content to be published to our administrators: If your church office uses Dropbox, please enter the email address associated with the account. We'll share a private folder with you into which you can drop items you'd like to have published.

Dropbox Email:

Office Computer:	None PC Mac Other / Don't Know


5. Statement of Belief / Authorization:

What We believe:
We believe that there is one God, eternally existent in three persons: Father, Son and Holy Spirit. We believe in the deity of our Lord Jesus Christ, in His virgin birth, in His sinless life, in His miracles, in His life-giving and atoning death through shed blood, in His bodily resurrection, in His ascension to the right hand of the Father, and in His coming personal return in power and glory. We believe the Bible to be the inspired, the only authoritative Word of God. We believe that for the salvation of lost and sinful people, regeneration by the Holy Spirit is absolutely essential. We believe in the present ministry of the Holy Spirit by whose indwelling the Christian is enabled to live a godly life. We believe in the resurrection of both the saved and the lost; those who are saved to the resurrection of life, and those who are lost to the resurrection of damnation. We believe in the spiritual unity of believers in our Lord Jesus Christ. (*Taken from National Association of Evangelicals â€“ see http://www.nae.net)
YES: I / We Believe this	*

I believe the information I have provided to be correct and hereby authorize Ecclesiact to publish church contact details, photograph, service times and other details on the community website.

Type your name to sign:	*

Mission Statement:

Manifesto: (BGEA, 1947)

Staff:

Advisory Council:

Ecclesiact® Trademarks:

Owner / Operator:

Signup

Community Member Signup Form

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