Registration Page

 
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Registration

 

Please complete and submit the following information to request access to the restricted areas of our web site.

 

Form submission is accepted only when your responses are complete and correctly formatted so please check your entries carefully.

 

Upon submission of this form, an email will be sent to verify your email address.  Please enable your mail filter to receive email from hallsvillechurch.org.  If you do not verify email receipt within 1 day of your form submission, your registration information may be deleted.  You may submit a new registration request if your registration information has been deleted.

 

Please note that access will not be approved if your identity cannot be verified.

 

We look forward to receiving your registration!

 

 


 

Your Name:

First Name:
Last Name:

 

Your email contact information:

Email Address:
Confirm Email Address:

 

Your phone contact information:

Phone Number:

 

 


 

Your physical street address.

Address 1
Address 2
City
State
Zip Code

 

Your mailing address; either street address or post office box.

Check this box if your physical address is your mailing address: 

Address 1 or PO Box
Address 2 or PO Box
City
State
Zip Code

 


 

Your identity verification.

 

Check this box if you are a member assembling with the

church of Christ in Hallsville. 

 

Check this box if you are known by a member assembling with

the church of Christ in Hallsville and indicate the member's

name.

Member Name

 

If you are neither a member or known by a member assembling

with the church of Christ in Hallsville, please provide information

on where you assemble for worship (or indicate 'Not Applicable')

and provide the name and phone number of a reference that

can verify your identity.

Assembly Name
Reference Name
Reference Phone Number

 


 

Your proposed Log-In credentials (User Name and Password).

 

Your preferred User Identification For This Web Site.

(At least 4 and no more than 12 characters or numbers with no spaces between characters)

User Name:

 

Your preferred Password For This Web Site.

(At least 6 and no more than 10 characters or numbers with no spaces between characters)

Password:

 


 

Enter the verification code in the box below here: