Page 17 | Bryant Lane Cowboy Church

Please fill out one form per family member over the age of 18. Minor children information will only need to be entered once on either the mother or fathers form.

Once the form is submitted, you will be contacted by a Pastor or Elder about your membership.

First Name (Required)

Last Name (Required)

Birthday (Required)

Mobile Phone (Required)

Home Phone

Email address (Required)

Would you like to receive emails or text alerts from BLCC? (Required)

Marital Status (Required)

If married, what is your spouses name?

Have you been Baptized? (Required)

If yes, when were you baptized?

If no, would you like to be contacted by a pastor or elder about being baptized?

Child name

Enter your children's name and DOB. Include email and cell phone if they have it. Please enter all children's information in the same text box.

How will you be joining BLCC ? (Required)

Church previously attended?

Please list name, city and state.

In what way(s) do you desire to serve within BLCC?

Based on your interests, abilities, gifts and time

Solve 5 + 1 = ?

Bryant Lane Cowboy Church

P.O. Box 177
Como, MS 38619

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