CIRCLE OF THE GREAT (COG)

Membership Form

1. NAME: _____________________________________________________________
2. DATE OF BIRTH: _____________________________________________________________
3. GENDER : _____________________________________________________________
4. RESIDENTIAL ADDRESS:__________________________________________________________
5. STATE OF ORIGIN _____________________________________________________________
6. L.G.A: _____________________________________________________________
7. PHONE NO _____________________________________________________________
8. E-MAIL ADDRESS: _____________________________________________________________
9. ACADEMIC QUALIFICATION______________________________________________________
10. OCCUPATION: _____________________________________________________________
11. HOBBIES: _____________________________________________________________
12. SKILLS / TALENTS: _____________________________________________________________

13a ARE YOU BORN AGAIN: __________________________________________________________

13b IF YES WHEN? _____________________________________________________________

14 WHICH CHURCH DO YOU BELONG TO:____________________________________________
15a ARE YOU IN A RELATIONSHIP: ___________________________________________________
15b IF YES, ARE YOU ENGAGED: ______________________________________________________

YOUR LIFE IS SHAPED BY THE BOOKS YOU READ AND THE PEOPLE YOU MEET

YOU ARE WELCOME!