ROA Forms | Member Number Request

Member Number Request

If you have never received, lost, or misplaced your Rock of Ages Member Number, please complete the form below to receive a Card. Your card may be picked up at the Information Table on the following Sunday. If there are any challenges with obtaining your member number, you will be contacted by the ANTS Support Team. Should you have any questions in the interim, please do not hesitate to contact us at ministry@roabc.org.

Current Date

First Name

Last Name:

Contact #

Email

Date of Birth

Marital Status

Married Single Divorced

If recently married, previous last name

Current Address

City

State

ZIP Code

Previous if Address (if current is less than 1 year):

Current Address

City

State

ZIP Code

Date Joined (approximately if you do not recall)

Please select one

Adult Child Youth