Membership Form

Please fill out this form completely for Membership**.

In the "First Name" field, please enter the name that you would like to be called. In the "Legal First Name" field, please enter your legal first name if it is different than the name you go by. If it is the same, please leave legal first name blank.

Any fields that are not applicable, please skip.

** I understand that I will not become an official member of Central Baptist Church until voting takes place at the next Quarterly Business Meeting. An email confirming membership will be sent at that time.

If you have any questions, please contact the church office, (870) 935-1950.

* First Name

* Last Name

Legal First Name

* Campus You are Attending for Membership?

* Who recommended the Online Membership Class to you?

* How long have you been attending Central Baptist Church?

* Occupation

Work Phone

* Mobile Phone

Entering your mobile phone will opt you in for receiving occasional updates (freq may vary) via text message. Reply STOP at any time to opt out. Reply HELP for more information. Message and data rates may apply. Privacy Policy

Home Phone

* Address

* City

* State/Province

* Zip/Postal Code

* Email

* Preferred Contact Method

* Birth Date

* Marital Status

* Spouse Name (if applicable)

Names and Birth Date of Children under 21 living at home

Parent/Guardian's Name (if under 18)

* Contact information will be used for internally for church purposes and given to church members upon request for invitations. If you do not want this information shared with church members, Please let us know.

* Have you committed your life to Jesus Christ and trusted Him for salvation?

* If you answered 'Yes' above, please indicate When you were saved and Where you were saved in the space provided.

* Have you been baptized by immersion (under water) after you committed your life to Christ?

* If you answered 'Yes' above, please indicate When you were baptized and Where you were baptized in the space provided.

If you desire to be baptized, please indicate what campus you would like to be baptized:

* Former church name and address:

* Were you a church member?

* I desire for the Central Baptist family to accept me as a committed member:

* Do you attend a CBC Life Group?

If Yes, name of group (or day/time group meets):

* Worship Service you Attend:

* Area of Interest in Serving

* I have completed the Central Membership class (sign below by entering full name)

Processing registration ...