Registration - Profile Update

Please fill out this form and click submit.

We use all the information you provide to serve you better. We really appreciate your effort to fill out all the information requested that are applicable to you.

Your First and Last Name (As it appears on your ID or DL)

*

Your Middle Name

Nickname

Gender

*

Please select one option.

Male Female

Birth Day

Phone

*

Home/work phone

Email

This address will receive a confirmation email

Marital Status

*

Please select one option.

Single Married Separated Divorced Widow(er)

Address

*

EEBC Member

*

Please select one option.

Yes No

Baptized

*

Please select one option.

Yes No

Baptized Year

Are you serving in EEBC in any group?

*

Please select one option.

Yes No

Please list all the ministries you are serving at EEBC 1-

2-

3-

4-

Please let's now the ministry you would like to involve in 1-

2-

Select the small groups you are in

*

Please select all that apply.

Bible Study Family Group I am not in bible study or family group

Name and phone number two people that knows you: 1-

*

Phone

2-

*

Phone

Family Information

If you don't have spouse and children, skip this section and submit the form.

Your Spouse Name

Spouse phone

Spouse Email

This address will receive a confirmation email

Spouse Birthday

Anniversary Date

Is your spouse EEBC member?

Please select one option.

yes no

Is your spouse serving in any group?

Please select one option.

Yes No

Please list the groups your spouse serving in:

Select the small group your spouse in:

Please select all that apply.

Family group Home (Bible study) group None of the above

First Child Name (First, Last)

Birthday (1st)

Second Child Name (First Last)

Birthday (2nd)

Third Child Name (First Last)

Birth Day (3rd)

Fourth Child Name (First Last)

Birthday (4th)

Fifth Child Name (First Last)

Birthday (5th)

Sixth Child Name (First Last)

Birthday (6th)

Description

Please fill out this form and click submit.

Please Fix the Following

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