Complete this form to request membership transfer to Village Seventh-day Adventist Church in Berrien Springs.

Name *

First

Last

Birthdate (accurate birthdays required to initiate church transfers) mm/dd/yyyy

Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Church where your current membership is. *

Address of Church with Current Membership:

Address Line 1

Address Line 2

City

State

Zip Code

Phone of Church with Current Membership

Name as recorded in church membership (if different from above)

First

Last

Comment