Membership Application Form

Thank you for taking the time to complete this online Membership Application. If you have any question about this form, please contact our Office Administrator, nikkiah@roserchurch.com . As soon as we receive your competed form, we will contact you as soon as possible about next steps. Thank you for your interest in becoming a Member at Roser!
Name(Required)
Wish to join Roser as:(Required)
Local Address(Required)
Alternate Address (if applicable)
Check box or text ROSER to 22828
MM slash DD slash YYYY
MM slash DD slash YYYY
Would you like us to order a Name Tag for you?(Required)
Would you like to be included in our church directory?(Required)
Would you like to submit a photo to be included in the church directory.(Required)
If you answer "yes" to this question, please email your photo to Nikkiah@roserchurch.com. Thank you.
This field is for validation purposes and should be left unchanged.