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Become A Member of MCOB Online
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Please submit your member details in the format firstname.lastname.  This way we can all keep in touch better. 

An example would be dan.petry


When you submit your request to become a member of this site and email will be sent to the site administrators. One of them must approve you as a member and give you permission to log into the site.


Fields with a "*" next to them are required.

First Name* Last Name*
Street Address
Other Address
City State/Province Zip/Postal Code
Region (Not U.S. or CAN) Country
Primary Phone Cell Phone
Email Address*
SMS Email Address
(An SMS email address is the email address used to send you text messages on your cell phone. Normally, it's your 10-digit phone number @ the domain used by your provider, for example, 2223334444@att.net)
Website Address

Gender

Birth Date

Check this box if you would like to include your profile in the member directory on our website.

Check this box if you would like to have your email address displayed in the member directory.

Check this box if you would like to have your street address displayed in the member directory.

Check this box if you would like to have your phone number displayed in the member directory.

Bio
(If you chose to include your name and email address in our Member Directory, you can also include a short biography or testimony. If you want to do that, enter it here.)

Interests
(This should be a simple, keyword-type list of interests separated by commas. Please, keywords or key-phrases only.)

Check this box if you would you like to receive Middlebury Church of the Brethren email updates.

Upload a Photo?
(This photo will be displayed with your information in the member directory. This image should be a jpeg [.jpg] image with no spaces or special characters in the filename.)

Login Information
This username and password will be used to allow you to login to the Middlebury Church of the Brethren community areas.

Username*
Password*
(Your password must be 6 characters or longer and be rated 'Good' or 'Strong'. Using a combination of numbers, upper & lower case letters and symbols will insure a good to strong password rating.)
Please tell us why you wish to register.*

NOTE: Do Not Alter These Fields:



Copyright 2005 Middlebury Church of the Brethren
Middlebury Church of the Brethren, 507 W. Bristol Street, Middlebury IN 46540
574 825 2955


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