Thank you for being a part of our Next Steps Class! Please complete the form below if your desire is to become a member here at FBC DeRidder!

Name

First Name

Last Name

Phone

(###)

###

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Email

Marital Status

Married

Single

Widow / Widower

Spouse Name

First Name

Last Name

Spouse Phone

(###)

###

####

Spouse Email

Child 1 (Name & Age)

Child 2 (Name & Age)

Child 3 (Name & Age)

Additional Children (Names & Ages)

Date

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

My Testimony

Please briefly describe your salvation experience! If you are married, you can both include your testimonies here.

Baptism

I desire to be baptized.

I've already experienced believers baptism.

I have questions about baptism and would like to speak with a pastor about it.

If you transferring your membership from another church, please type the church name and city where it is located here.