Become a member

New Membership Form

Welcome! Please complete the form to become a member of Shiloh Missionary Baptist Church. An (*) denotes a required field. We look forward to connecting with you! Please click the submit button at the bottom of the form upon completion to ensure your information is received.

Date Joined(Required)

Member Information

First name(Required)

Last name(Required)

Gender (Required)

Male

Female

Date of Birth(Required)

Marital Status (Required)

Single

Married

Widowed

Divorced

Spouse's Name (First and Last Name)

Spouse Date of Birth

Joined as a Family?(Required)

Yes

No

Grade (if youth)

How are you coming into fellowship with Shiloh?(Required)

Baptism

Christian Experience

Restoration of Membership

Transfer Letter

Address (Street, City, State Zip)(Required)

Email(Required)

Phone(Required)

Spouse's Cell Number

Spouse's Email

SHILOH MISSIONARY BAPTIST CHURCH

(860) 346-8295

Shilohbaptistmdtn@comcast.net

346 Butternut Street

Middletown, CT 06457

STAY CONNECTED

First name(Required)

Last name

Email(Required)

Yes, subscribe me to church communications

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