MembershipApplication Personal InformationYour Name First Last Spouse's Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Work PhoneHome PhoneEmail Marital StatusSingleMarriedDivorcedWidowedAnniversary Date Date Format: MM slash DD slash YYYY Additional InformationDate you started attending Harvest Muskoka Date Format: MM slash DD slash YYYY Baptism*I am requesting baptism. Please contact me for the next baptismal service.Yes, I have been baptized (believers baptism) in the name of the Father, Son and Holy Spirit after conversion, as a testimony to my faith in Christ.When? Date Format: MM slash DD slash YYYY Where?Harvest Essentials I have completed all three Harvest Essentials classes. Date Date Format: MM slash DD slash YYYY Previous Church Membership Yes, I have previously been a member of another church. What is the name of the church(es), and when did you last attend (approximately)?Are there any outstanding issues between you and the leadership/members of any previous churches? Household InformationPlease complete the following information for our church database. It is helpful to have as much information as possible, but feel free to omit any information that you are not comfortable providing to us. None of this information will be shared with any outside organization.Head of HouseholdNameDate of BirthCell NumberEmail Address SpouseNameDate of BirthCell NumberEmail Address ChildNameDate of BirthCell NumberEmail Address Additional Information(summer or college addresses, children or spouse with different last name, anything else you would like us to know) Consent ReleaseBy signing this form, you give your consent to Harvest Bible Chapel Muskoka to use this information for the purposes of its operation.Date Date Format: MM slash DD slash YYYY Signature My Story1. “I was...”What was your life like before you accepted Jesus Christ as your Lord and Saviour?2. “But God...”How did you come to surrender your life to Jesus Christ?3. “And now...”What is the Lord doing in and through your life now? Walk with ChristSmall GroupI am already in a Small GroupI’m not in a Small Group; please assign one to me!Small Group that I am a part ofWork for ChristAreas you are currently servingAreas you are interested in servingGivingInterested in Pre-authorized GivingYesNoDoctrinal StatementPlease Read Our Doctrinal Statement (myharvestchurch.ca>about>what we believe>doctrinal statement) I have read and will submit to the doctrinal statement