Divine Visitation Assemblies

I have received Jesus Christ as my personal Lord and Saviour; and desire to join the Divine Visitation Assemblies Covenant. Therefore, I hereby apply for membership.

* indicates required

Email Address *

First Name

Last Name

Birthday

Ex: Jan 1 2020

Address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Phone Number *

Church Category *

Main Church: 20-Above years old
Youth Excel: 11-19 years old

DVA Children Church: 0-10 years old

Tom, Liam, Jane

Date Baptized

Home Number

MEMBERSHIP FORM