Membership Database Information Form

Membership Database Information

Family Unit Data

* Indicates required field

Last Name *

Individual Name(s) *

Local Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Second Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number at Second Address *

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

Individual Member Data

Please complete for each member of your family. If more family members than the spaces provided, please use the large textbox at the bottom of this form.

Full Name of Individual #1 *

First

Last

Personal Phone Number *

Email *

Gender *

Marital Status *

Occupation or Grade Level, if Student *

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) (approximations are okay) *

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 *

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) (approximations are okay) *

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 *

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. *

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