Omaha Christian Singles

Membership Application

Please Print Clearly

New Membership [   ]                 Renewal [   ]               

Name__________________________________________ Date_____________

Address________________________________________     Unlisted [   ]

City__________________________________ State______ Zip_____________

Home Phone (        )-_________-_________     Unlisted [   ]

Birth Date (Month\Day)_____________\________

Email address____________________________________[Confidential]

                                   Please Print Clearly

Would you be willing to host functions in your home?  Yes____ No____

Do you have access to a facility to host functions? Yes___ No ___

If so, where_____________________________________________

Do you have children? Yes___No___

Would you be interested in family  type activities? Yes___ No___

Would you be interested in serving or assist on any committees Yes___ No___

If yes on which committee  would you be interested?

Social [   ]     Public Relations [   ]   Refreshments [   ]  Family [   ]  Community Service [    ]

Instructions: High light application form (with your left mouse button) and print it out. Then fill it out and mail it along with your $18.00 ( Make checks payable to OCS, Omaha Christian Singles ) ( Send checks to Membership Director ) Listed below.

Membership Director 

Diane Holmes 

803 N. 74th Ave.  

Omaha, Ne. 68114

If you have any questions please contact Diane Holmes the Membership Director by email at the email address below.

dholmes17@cox.net

OCS USE ONLY

Date Received____________   Amount Received_____________ 

Expiration Date____________