Prospective Member Form

Please complete if you are interested in making ICOG your church home.

Your name *

Email address *

What is today's date? *

My Decision Today: *

select all that apply

Accepted Christ as Lord and Savior

Become a Prospective Member of ICOG

Address *

Phone number *

Birthdate *

Gender *

Marital status *

Please upload your photo

Please upload your photo or have one taken of you.

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Add up to 5 files. Maximum file size 10 MB.

Were you baptized? *

How old were you when you were baptized?

Do you need to be baptized?

If not baptized by immersion or were too young to remember.

Household Information

Household members

Upload photos of individuals

Please upload photos of each person in your household.

No files currently selected

Add up to 5 files. Maximum file size 10 MB.

Upload a picture of your entire household.

Please upload a family photo.

No files currently selected

Add up to 5 files. Maximum file size 10 MB.

Contact Name: *

In Case of Emergency

Contact Relation to you: *

How is your emergency contact related to you?

Contact's Phone Number: *

What is your emergency contact's number?

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