Dakota Conference

New Member Reporting

This form is meant to be filled out by the local church clerk or pastor.

Name of new member

Name of church joined

Member by

Baptism Profession of Faith Re-baptism

Baptized by

Date of baptism

Place of baptism

Name of parents (if living at home)

Address

Home phone

Cell phone

Email address

Date of birth

Marital status

Gender

If new family, list non-member family members residing with member

Name of person reporting