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Welcome to The Word Center
Pastor Marlon McDuffie
PLEASE FILL OUT ALL INFORMATION BELOW
First name
*
Last name
*
Date of Birth
*
Month
Month
Day
Year
Address
*
City
*
Zip Code
*
Home Phone
Work Phone
Mobile Phone
*
Email
*
Marital Status
*
Spouse's Name (if married)
Is your spouse joining also?
Yes
No
Anniversary Date
Spouse's Date of Birth
Spouse's Mobile Phone
Spouse's Email
Do you have children joining also?
*
Yes
No
If yes, please list each child's name, sex, age and birthdate
Child Two
Child Three
Child Four
Child Five
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