Presbyterian Church of Ghana
Shalom Congregation
Membership Registration Form
All fields with
*
are required
Personal
Family, Work & Church
Additional
Personal Information
Title
*
Mr
Mrs
Ms
Dr
Other
Surname
*
Other Name(s)
*
Gender
*
Male
Female
Date of Birth
*
Nationality
Select your nationality
Ghanaian
Togolese
Ivorian
Burkinabe
Other
House Address
Email Address
Primary Mobile No
*
Other Mobile No(s)
Next
Family Information
Name of Biological Father
Living
Deceased
Name of Biological Mother
Living
Deceased
Marital Status
*
Single
Married
Widowed
Divorced
Legally Separated
Name of Spouse
*
Spouse Tel
Number of Children
Academic and Work Information
Highest Academic Qualification
N/A
Basic
Secondary
Tertiary
Occupation / Profession
Are you a student?
Yes
No
Name of School/Institution
Church and Baptism Information
Membership No (optional)
Are You Baptized?
Yes
No
Date of Baptism
Place of Baptism
Are you a Communicant?
Yes
No
Date of Confirmation
Place of Confirmation
Generational Group
MF
WF
YAF
YPG
JY
CS
Service Group
Church Choir
Singing Band
BSPG
Usher
Media Team
Royals
CST
JYT
Other
Previous
Next
Languages
English
Twi
Ga
Ewe
Other
When did you join Shalom?
*
(
Enter estimated if you do not remember exact date
)
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