Contact Information Form

Have you moved recently? Do you have a new phone number or email address? Would you like to get to know us better? Use this form to request Bible studies, baptism, a pastoral staff visit/call, counseling, transfer of membership, or to update your information in the EBC membership directory. If transferring to Emmanuel-Brinklow, list the ministries where you might want to serve.

(*) Denotes required fields

 Update my information in the church directory (shown below)
 New to the Washington Metro Area
 Bible Study
Baptism
I need a pastoral staff visit/call (sick family member, counseling).
 Transfer my membership to Emmanuel-Brinklow.
        Name & address of church transferring from
Transfer my membership from Emmanuel-Brinklow.
        Name & address of church transferring to  
 Contact Information
First Name*:
 Last Name*:

Birth Date:

 
Address*:
    
City*:
   State*:
 Zip*:

 
Home Phone*:
( ) -
Cell Phone:
( ) - 		Email*:
 Spouse

First Name
Last Name

Birth Date:

Children

First Name
Last Name

First Name
Last Name

Birth Date:

Birth Date:
   

First Name:
Last Name:

First Name
Last Name

Birth Date:

Birth Date:

I would like to serve in the following ministries:
Other request:


 

NOTE: The Emmanuel-Brinklow Adventist Church does not give any information you submit to third parties. This information is kept confidential and is used solely for the purposes of conducting church business.

 
Emmanuel-Brinklow Home PagePastor Marcellus T. Robinson


Our Location

18800 New Hampshire Ave,
[Mail: P.O. Box 519]
Ashton, MD 20861
Phone: (301) 774-0400
Fax: (301) 774-0722

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