Member Information Update

The House of the Lord, Airfield, Benoni

An assembly of the Full Gospel Church of God in SA

On-Line Member Information Update

YOUR INFORMATION HAS CHANGED
This is the place to advise us of the changes!

Do the following:
1) Complete the required information on this form plus any information that has changed, then press the "Submit" button at the end.
2) You will receive a confirmation that your information has been submitted.
3) We will send you an email if any additional information is required.

Lifestyle Status of person completing this application (Required)

Married Woman living with husband Married Man living with wife Child under 21 living with parent(s) Child under 21 living on your own Single over the age of 20 Married but separated Divorced Widow(er)

Husband's Surname

Husband's Initials

Wife's Surname

Wife's Initials

Father's Surname

Father's Initials

My Information (Required)

Surname

First Name

Initials

Gender

Male Female

Email Address

My Information (Optional - only required if changed)

Physical Address

Number Street, Suburb, City, Postal Code

Postal Address

Number Street, Suburb, City, Postal Code

South African ID Number or Passport Number

Home Phone Number

Work Phone Number

Cell Phone Number

Attendance at the House of the Lord. I attend:

Most Sundays plus a mid-week activity Only on Sundays Occasionally on Sundays

Date Information - If the exact date is not known complete only Year & Month or Year only

Year Born-Again

Month Born-Again

Day Born-Again

Year Baptised Water

Month Baptised Water

Day Baptised Water

Year Baptised Holy Spirit

Month Baptised Holy Spirit

Day Baptised Holy Spirit

Year of Birth

Month of Birth

Day Birth

Marriage Information - only if married or previously married.

Marital Status

Year Married

Month Married

Day Married

Year Divorced

Month Divorced

Day Divorced

My Spouse's Information

Surname

First Name

Initials

Physical Address

Number Street, Suburb, City, Postal Code

Postal Address

Number Street, Suburb, City, Postal Code

South African ID Number or Passport Number

Home Phone Number

Work Phone Number

Cell Phone Number

Email Address

My Children's Information

Complete this information only for children who are living with you!

1st Child's Surname

First Name

Initials

Cell Phone Number

2nd Child's Surname

First Name

Initials

Cell Phone Number

3rd Child's Surname

First Name

Initials

Cell Phone Number

4th Child's Surname

First Name

Initials

Cell Phone Number

Well done - we're ready to go. All you have to do now is press the "Submit" button, then please do not leave this page until you receive confirmation that we have received your information! (Should take less than a minute)
We WILL get back to you if we need any further information.