By making sure that the information you provide on this form is correct, after verification you shall be notified on the approval of this request through SMS and/or email.

Basic Information
Surname
FirstName
OtherNames
Gender
Marital Status
Age Group
Contact Information
Home Address
Phone Number
Email Address
Occupation/Profession
Next of Kin (Name)
Phone Number
Address
More Information
Are you a born again?
If yes, Date of Coversion
Have You Been Previously Baptized By Immersion?
If yes, At What Age?
Church of Baptism
How Long Have You Been In House On The Rock?
Have You Been Through Workers In Training Programme?
If yes, Please Indicate
Are You A Worker In HOTR?
If yes, What Department?
If No, Select Any 3 Church Departments You Would Like To Serve In?
Any Medical Issue/Concern?
If yes, Please state