BIC ONLINE MEMBERSHIP APPLICATION

Your info is not given or sold to third party.

NOTE: NO MEMBERSHIP will be approved without complete mailing address or a working phone number. All membership requests must confirm their email within 30 days after sending their online form. BIC can not accept membership from anyone who lives in or is a citizen of Iran, Syria, Libya, Cuba or Sudan.

APPLICANT INFORMATION Full Name: Are you a Born Again Christian: Yes No Confused Postal Address: City: State: Postal Code: Phone #: Country: Marital Status: Single Married Widow Divorced Email Address: *required (Notes: If your email account has a 'Bulk' or 'Spam' box such as Yahoo email accounts, please always check the 'Bulk' box when checking your emails. Your email host Yahoo may err and deliver our Emails in the 'Bulk' or 'Spam' box. Birthdate: (month) January February March April May June July August September October November December (Day) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 (year) Languages spoken: Are you currently a active member in a local church? yes or no yes no sometimes Church Name: BIC MEMBERSHIP COMMITMENT Why do you wish to be a part of Brother in Christ Inc.? Do you use Yahoo Messenger? yes or no yes no Yahoo Screenname: Do you use MSN Messenger? yes or no yes no MSN ID (email you use for MSN): Do you have a Account with Facebook.com? yes or no yes no How often are you on the internet? Choose One Every Day Weekly Bi-Weekly Monthly Depends Financially OTHER INFORMATION I am a student in school. Name of School: I am currently working. Type of Occupation: Check box if you are capable to give a donation. (optional) I have read and understand the guidelines and rules to protect BIC from Scams and Fraud. (required) I have read and understand the mission, vision, and purpose of BIC Ministry. (required) I have read and understand the rules and expections of being a BIC member and what can cause the termination of my membership. (required) I confirm all the above information submitted is correct. (required)