ACME CHURCH
123 Maple Street Anytown, PA 17101 info@example.com - www.example.com (123) 1234567
Church Membership Questionnaire
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How old are you?
18-25
26-35
36-45
46-55
56-65
Other
How did you hear about us?
A Church Member
A Friend
A Family Member
A Cast or Crew Member
Other
How would you describe your walk with Jesus Christ?
I'm looking for a church home
I have a church home, but I'm not saved
I have a church home and I am saved
I am spiritual, but I don't go to church
I prefer not to answer
Are you active on social media? (ie: Facebook, Twitter, or Instagram)
Yes
No
If so, what is your handle?
How often do you check your social media per day?
Randomly Throughout the Day
In the Morning
On My Lunch Hour
At Night
On the Weekend
N/A
How often do you check your email?
Several Times Throughout the Day
In the Morning
On My Lunch Hour
At Night
On the Weekend
Do you vacation a lot in the summer?
Yes
No
When do you usually travel? Check all boxes that apply.
May
June
July
August
September
Other
If we were to sell merchandise in the future, what items would you be most interested in? Check all boxes that apply.
T-Shirts
Mugs
Bible Covers
Calendars
Keychains
Phone Covers
Planners
Canvas Bags
Submit
Should be Empty: