Antioch Baptist Church Upper Marlboro

Member Intake Form

Member Information

Birth Date

Membership Date (if known)

Other Members of Household

Spouse

Birth Date

Antioch Member?

Yes No

Membership Date

Wedding Anniversary Date

Children

Birth Date

Antioch Member?

Yes No

Membership Date

Birth Date

Antioch Member?

Yes No

Membership Date

Have more than two children? Add them in the message box below.