Northern Hills Baptist Church

First Name (Required)

Last Name (Required)

Email (Required)

Mailing Address (Required)

Date of Birth (Required)

Gender (Required)

Are you married? (Required)

What is your spouse's name?

(Both spouses will need to complete an application.)

Have you repented and trusted Christ as your Lord and Savior? (Required)

If yes, when?

Have you been baptized by immersion? (Required)

Are you currently a member of a church? (Required)

If so, provide an e-mail address, name, and city of the church.

Have you attended the New Members class? (Required)

Why do you want to join Northern Hills? (Required)

What is your occupation? (Required)

Please list any children and their dates of birth.

Northern Hills Baptist Church

17211 NE 180th St, Holt, MO 64048