KEI MEMBER?

Do you live in the state of Rhode Island? Do you live in the state of Rhode Island? Yes No

First Name

Last Name

Street Address

Street Address Line 2

City

State

Zip Code

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Date of Birth E.g. (MM-DD-YYYY)

Gender Gender Male Female

Email Address

Phone Number E.g. 000-000-0000

Are you a born again Christian? Are you a born again Christian? Yes No

Today I Decided To Today I Decided To Accept Jesus Christ as my Lord and Savior Become a Member Get Baptized Re-dedicate my life to Jesus Christ

What brought you to The EMBASSY? What brought you to The EMBASSY?FriendFamily MemberSocial MediaOther

I am Interested in volunteering in one or more areas below: (optional) I am Interested in volunteering in one or more areas below: (optional) Audio/Visual/Production Children/Youth Communication & Social Media Discipleship Hospitality Ministry Outreach Worship & Arts