Date:
Name: First: Middle
Initial:
Last:
Date of
Birth: Email:
Phone/Cell#
Address:
City State: Zip:
Marital status:
Wife’s
Name Children:
Names/Ages
Sons: Daughters:
Age at which you
accepted Christ as Lord:
Age at which you were
baptized:
Age at which you were
married:
Sunday School Class
you attend:
Worship Service you attend: Sunday 9am Wednesday 7pm
Number of Days you
read your Bible each week:
Frequency with which
you pray:
Have you ever shared
the Gospel and led someone to faith in Jesus as Lord? : Yes No
Spiritual battles you
are fighting now:
Do you want to be
involved in The One to One Discipleship Training (Operation Timothy) : Yes No Not ready at this time
What ministries are
you serving in now?
Have you taken
P.L.A.C.E training yet ? :
Hobbies:
Job/Employment/Grade
in School :
Action Teams You want to Serve On: Publicity/Technology Events/Fun Activities Operation Timothy Coordinator Helps/Community Action Leader's Council Praise/Worship