Discover Crosspoint Household Roll FAMILY/HOUSEHOLD ROLL *required fields Family Last Name* First Person - Full Name* First Person - First and/or Last Names*(As Desired on Nametag) First Person - Marital Status*Please selectMarriedSingleEngagedDivorcedRemarriedWidowedSeparatedPartneredFirst Person - Date of Birth* MM slash DD slash YYYY First Person - Approximate year baptized? Second Person? Yes Second Person - Full Name* Second Person - First and/or Last Names*(As Desired on Nametag) Second Person - Marital Status*Please selectMarriedSingleEngagedDivorcedRemarriedWidowedSeparatedPartneredSecond Person - Date of Birth* MM slash DD slash YYYY Second Person - Approximate year baptized? Third Person? Yes Third Person - Full Name* Third Person - First and/or Last Names*(As Desired on Nametag) Third Person - Marital Status*Please selectMarriedSingleEngagedDivorcedRemarriedWidowedSeparatedPartneredThird Person - Date of Birth* MM slash DD slash YYYY Third Person - Approximate year baptized? Fourth Person? Yes Fourth Person - Full Name* Fourth Person - First and/or Last Names*(As Desired on Nametag) Fourth Person - Marital Status*Please selectMarriedSingleEngagedDivorcedRemarriedWidowedSeparatedPartneredFourth Person - Date of Birth* MM slash DD slash YYYY Fourth Person - Approximate year baptized? Fifth Person? Yes Fifth Person - Full Name* Fifth Person - First and/or Last Names*(As Desired on Nametag) Fifth Person - Marital Status*Please selectMarriedSingleEngagedDivorcedRemarriedWidowedSeparatedPartneredFifth Person - Date of Birth* MM slash DD slash YYYY Fifth Person - Approximate year baptized? Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Mailing Address(if different) Main/Home Phone*Main Email* Mobile HimEmail Him Mobile HerEmail Her Campus*Please selectNicevilleBluewater BayNorth CrestviewSouth CrestviewFreeportOnline1. Place of EmploymentEmployer (Him) Type of Work (Him) Work Phone (Him)Employer (Her) Type of Work (Her) Work Phone (Her)2. Ethnic GroupEthnic Group (Him)Please selectAfrican-AmericanAsianCaucasianHispanicNative AmericanPacific IslanderEthnic Group (Her)Please selectAfrican-AmericanAsianCaucasianHispanicNative AmericanPacific Islander3. Date to JoinDesired Date to Join MM slash DD slash YYYY Desired Place to Join 4. Joining MethodJoining by: (Him) Baptism Profession of Faith Letter of Transfer Re-affirmation of Faith Baptism (Him) Immerse Pour Sprinkle Transferring from (Him)Church Name, City, and State you are transferring fromJoining by: (Her) Baptism Profession of Faith Letter of Transfer Re-affirmation of Faith Baptism (Her) Immerse Pour Sprinkle Transferring from (Her)Church Name, City, and State you are transferring from5. Giving PreferenceGiving Preference(Would you prefer to) Give Electronically Receive Mailed Giving Envelopes Monthly Receive Mailed Giving Envelopes Weekly Give via Offering plate Giving Statement(Would you prefer to Receive Statements by) Email Statement Printed Statement CAPTCHA Δ
