Your Name (required)
Address (required)
Date of Birth (required)
Telephone (required)
Your Email (required)
Have you accepted Christ as your savior? (required) YesNo
If you are “Born Again” how do you know that you are? (required)
Are you married? (required) YesNo
Name of spouse
Do you ingest alcoholic or any addictive substances? YesNo
Do you renounce any involvement with the occult? YesNo
As a member of Destiny, do you commit to living your life according to the biblical standards that are outlined in the Holy Bible YesNo
Do you commit to submitting to the Pastor and leaders of Destiny? Yes
Will you recognize leadership and Board as the final authority for discipline and correction here at Destiny? YesNo
Please check the appropriate options: A. I desire to be Water Baptized Yes
B. I am applying for Membership Yes
