Member Information Update
The North American Division of Seventh-day Adventist requires all churches to update membership information on eAdventist.net. We need information for all members of the family including newborns. All information supplied in this form is CONFIDENTIAL and will not be published without expressed permission from the person providing the information. *Required information
Primary Family Member
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Membership
*
Member
Nonmember
Gender
*
Male
Female
Birthday
*
-
Month
-
Day
Year
Date
Marital Status
*
Single
Married
Widowed
Divorced
Separated
Date of Marriage
-
Month
-
Day
Year
Date
Name of Spouse
Language
*
Please indicate all languages that you use in worshiping God.
Ethnic Class
*
Caucasian
African American/African Descent
Hispanic
Asian/Pacific Islander
Native American/First Nation
Middle Eastern
Other
Occupation
*
Please indicate your current occupation,
Name of School Currently Attending
If you are currently a student, please fill out the next few questions. If you are currently a student, you may skip the next questions related to schools.
Current Grade
Is Your Current School SDA?
SDA
Non-SDA
Please indicate information that you do not want in the church directory.
Telephone Number
E-mail address
Do you have other family members?
If you have no other family members, select SUBMIT below. If you have other family members, continue to type in the information for your other family members.
Submit
Family Member #1
Family Member #1
Please fill out a form for each of your family members in your household. If you have children please fill out these sections so we can have information for the whole family. If this family member has a different address, please fill out a different form.
Is this person a member of Jackson Heights Church?
Yes
No
Relationship
How is this person related to the person who started filling out this form?
Name
First Name
Last Name
Gender
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
Marital Status
Single
Married
Widowed
Divorced
Separated
Date of Marriage
-
Month
-
Day
Year
Date
Name of Spouse
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Occupation
Language - This information is required.
Please indicate all languages that you use in worshiping God.
Ethnic Class - This is required.
Caucasian
African American/African Descent
Hispanic
Asian/Pacific Islander
Native American/First Nation
Middle Eastern
Other
Name of School Currently Attending
If you are currently a student, please fill out the next few questions. If you are currently a student, you may skip the next questions related to schools.
Current Grade
Is Your Current School SDA?
SDA
Non-SDA
Please indicate information that you do not want in the church directory.
Telephone Number
E-mail address
Do you have other family members?
If you have no other family members, select SUBMIT below. If you have other family members, continue to type in the information for your other family members.
Submit
Family Member #2
Family Member #2
Please fill out a form for each of your family members in your household. If you have children please fill out these sections so we can have information for the whole family. If this family member has a different address, please fill out a different form.
Is this person a member of Jackson Heights Church?
Yes
No
Relationship
How is this person related to the person who started filling out this form?
Name
First Name
Last Name
Gender
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
Marital Status
Single
Married
Widowed
Divorced
Separated
Date of Marriage
-
Month
-
Day
Year
Date
Name of Spouse
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Occupation
Language - This information is required.
Please indicate all languages that you use in worshiping God.
Ethnic Class - This is required.
Caucasian
African American/African Descent
Hispanic
Asian/Pacific Islander
Native American/First Nation
Middle Eastern
Other
Name of School Currently Attending
If you are currently a student, please fill out the next few questions. If you are currently a student, you may skip the next questions related to schools.
Current Grade
Is Your Current School SDA?
SDA
Non-SDA
Please indicate information that you do not want in the church directory.
Telephone Number
E-mail address
Do you have other family members?
If you have no other family members, select SUBMIT below. If you have other family members, continue to type in the information for your other family members.
Submit
Family Member #3
Family Member #3
Please fill out a form for each of your family members in your household. If you have children please fill out these sections so we can have information for the whole family. If this family member has a different address, please fill out a different form.
Is this person a member of Jackson Heights Church?
Yes
No
Relationship
How is this person related to the person who started filling out this form?
Name
First Name
Last Name
Gender
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
Marital Status
Single
Married
Widowed
Divorced
Separated
Date of Marriage
-
Month
-
Day
Year
Date
Name of Spouse
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Occupation
Language - This information is required.
Please indicate all languages that you use in worshiping God.
Ethnic Class - This is required.
Caucasian
African American/African Descent
Hispanic
Asian/Pacific Islander
Native American/First Nation
Middle Eastern
Other
Name of School Currently Attending
If you are currently a student, please fill out the next few questions. If you are currently a student, you may skip the next questions related to schools.
Current Grade
Is Your Current School SDA?
SDA
Non-SDA
Please indicate information that you do not want in the church directory.
Telephone Number
E-mail address
Do you have other family members?
If you have no other family members, select SUBMIT below. If you have other family members, continue to type in the information for your other family members.
Submit
Family Member #4
Family Member #4
Please fill out a form for each of your family members in your household. If you have children please fill out these sections so we can have information for the whole family. If this family member has a different address, please fill out a different form.
Is this person a member of Jackson Heights Church?
Yes
No
Relationship
How is this person related to the person who started filling out this form?
Name
First Name
Last Name
Gender
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
Marital Status
Single
Married
Widowed
Divorced
Separated
Date of Marriage
-
Month
-
Day
Year
Date
Name of Spouse
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Occupation
Language - This information is required.
Please indicate all languages that you use in worshiping God.
Ethnic Class - This is required.
Caucasian
African American/African Descent
Hispanic
Asian/Pacific Islander
Native American/First Nation
Middle Eastern
Other
Name of School Currently Attending
If you are currently a student, please fill out the next few questions. If you are currently a student, you may skip the next questions related to schools.
Current Grade
Is Your Current School SDA?
SDA
Non-SDA
Please indicate information that you do not want in the church directory.
Telephone Number
E-mail address
Do you have other family members?
If you have no other family members, select SUBMIT below. If you have other family members, continue to type in the information for your other family members.
Submit
Family Member #5
Family Member #5
Please fill out a form for each of your family members in your household. If you have children please fill out these sections so we can have information for the whole family. If this family member has a different address, please fill out a different form.
Is this person a member of Jackson Heights Church?
Yes
No
Relationship
How is this person related to the person who started filling out this form?
Name
First Name
Last Name
Gender
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
Marital Status
Single
Married
Widowed
Divorced
Separated
Date of Marriage
-
Month
-
Day
Year
Date
Name of Spouse
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Occupation
Language - This information is required.
Please indicate all languages that you use in worshiping God.
Ethnic Class - This is required.
Caucasian
African American/African Descent
Hispanic
Asian/Pacific Islander
Native American/First Nation
Middle Eastern
Other
Name of School Currently Attending
If you are currently a student, please fill out the next few questions. If you are currently a student, you may skip the next questions related to schools.
Current Grade
Is Your Current School SDA?
SDA
Non-SDA
Please indicate information that you do not want in the church directory.
Telephone Number
E-mail address
Submit
Should be Empty: