Choose all that apply *

(A STREAMS LIVE member is a person outside the city of Indy that connects with The Streams Church)

I would like to become a member

I received Christ

I rededicated my life to Christ

I want to become a STREAMS LIVE member

I was invited by...

First Name

Last Name

Name *

First Name

Last Name

Guardian Name (If under 18)

First Name

Last Name

Birthday

MM

DD

YYYY

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Care Coach

(For internal use only)

First Name

Last Name