Membership Database Information Form

Individual Name(s) *

Local Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Second Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number at Second Address *

Dates at Second Home (mm/dd - mm/dd) *

Full Name of Individual #1 *

First

Last

Personal Phone Number *

Email *

Gender *

Marital Status *

Occupation or Grade Level, if Student *

Communicant in Good Standing *

Yes No

Membership Status *

Active Inactive Shut-in Associate (part-time member at other church)

If you would like your membership transferred from another church, please provide the name and address of the church below. *

Birthday (mm/dd/yyyy) *

Place of Birth *

Baptismal Date (mm/dd/yyyy) *

Place/Parish of Baptism *

Confirmation Date (mm/dd/yyyy) *

Place/Parish of Confirmation *

Notes or information you would like to add: *

Full Name of Individual #2 *

First

Last

Personal Phone Number *

Email *

Gender *

Occupation or Grade Level, if Student *

Communicant in Good Standing *

Yes No

Member Status *

Active Inactive Shut-in Associate

Marital Status *

If you would like your membership transferred from another church, please provide the name and address of the church below. *

Birthday (mm/dd/yyyy) *

Place of Birth *

Baptismal Date (mm/dd/yyyy) *

Place/Parish of Baptism *

Confirmation Date (mm/dd/yyyy) *

Place/Parish of Confirmation *

Notes or information you would like to add: *

Full Name of Individual #3 *

First

Last

Personal Phone Number *

Email *

Gender *

Marital Status *

Occupation or Grade Level, if Student *

Communicant in Good Standing *

Yes No

Membership Status *

Active Inactive Shut-in Associate

If you would like your membership transferred from another church, please provide the name and address of the church below. *

Birthday (mm/dd/yyyy) *

Place of Birth *

Baptismal Date (mm/dd/yyyy) *

Place/Parish of Baptism *

Confirmation Date (mm/dd/yyyy) *

Place/Parish of Confirmation *

Notes or information you would like to add: *

Please submit additional family member information below. Include name, contact info, gender, birthday, and baptismal, confirmation, communicant, and membership status. *

Sunday Service Times
8:00 am - Eucharist (spoken)
9:15 am - Education Hour for Adults
9:15 am - Children and Youth Sunday school
10:30 am - Eucharist with Music
9:15 am - 11:45 am - Nursery Available

Eucharist with Anointing for Healing
Wednesdays at Noon

Morning Prayer at Panacea Coffee House
Fridays at 8:00 am

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Membership Database Information

Family Unit Data

Individual Member Data