Network Membership Registration

"*" indicates required fields

Contact Information

Primary Contact Name*

First Last

Primary Contact Email*

This is the email where we can contact you directly. You will enter a church email below.

Primary Contact Phone

Secondary Contact Name

First Last

Secondary Contact Email

Secondary Contact Phone

Church Information

Church Name*

Church Email*

Church Phone*

Church Street Address*

Street Address Address Line 2 City State ZIP Code

Is there are different Church mailing address?*

yes

Church Mailing Address If Different from Street Address*

Street Address Address Line 2 City State ZIP Code

Date and Time of your Messy Church*

Denominational Affiliation

Get Started in Messy Church

Have you or someone from your church attended a "Get Started in Messy Church" session?

Yes

Messy Church Values

Messy Church USA adheres to the five values of Messy Church International: 1) Christ-Centered, 2) All ages together, 3) Creativity, 4) Hospitality and 5) Celebration. Read more details of the values here.

I have read, understood, and will support the values of Messy Church in our locality.

Messy Church USA Privacy Policy

I have read, understood, and accept the Messy Church USA privacy policy.

Health and Safety

We will adhere to the health and safety laws and guidelines applicable within our legal jurisdiction (denomination, city, region, state)

Signature

Network Membership

Total

NOTE: The email address that you enter on the subsequent "Account & Billing" page will the the "owner" of the membership and their user account will manage your membership. If you want this to be someone other than YOU, enter their email address & info on the following pages. (The info above is for your directory listing.)

Name

This field is for validation purposes and should be left unchanged.