Membership Form

Membership of HCIC is free.

I wish to: *

APPLY for

RENEW my membership

Spiritual requirements: *

I believe

in Jesus Christ as my Lord and Saviour according to the Scriptures and agree with the Statement of Faith and Goals of Health Care In Christ Inc - About Us .

Enter your name here as acceptance of the above statement: *

Date of acceptance: *

Title: *

Christian name: *

Surname: *

Home Details

Home address: *

Suburb: *

State: *

Postcode: *

Phone/mobile: *

Email:

Work Details

Occupation:

Workplace:

Phone:

Email:

Church: *

Prayer:

I wish to support HCIC in prayer

Do you have a prayer group at work?

Would you be interested in starting one?

I have some prayer requests:

Donations to assist advancing the Kingdom of God in health care

One off donation

I wish to support HCIC with a donation of: $

Regular donation

I wish to support HCIC on a regular basis I will forward: $

every:

Credit Card donations can be made by phoning the office 02 9365 7137 or on our Donations page.

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