Register - VNTB

In order to become a member of the Vida Nueva Tampa Bay online community, please complete and submit this form for approval.

Your Information

First Name

Last Name

Tag Name

City

State

Zipcode

Primary Phone

Type

Alternate Phone

Type

Email Address

Date of Birth

Shirt Size:

Address

Address Line 2

Gender:

Male

Female

Clergy: No

Yes

Married: No

Yes

Licensed Medical Professional: No

Yes

Church

School

Special medical and/or dietary needs

Talents

Talent 1

Talent 2

Talent 3

Talent 4

Select Musical Talents

Guitar

Bass

Keyboard

Drums

Vocals

Other

Any other talents or musical instruments not listed?

Emergency Contact Info

Full Name

Phone Number

Other Weekend Experience

Other 3 day weekends?

Please list the Weekend and Location you attended as a candidate. Also, list any weekend experience as a server with all other 3 day communities. Please indicate: Location, 3 day name & weekend # and position.

Other experience details