Saint Mark United Methodist Church Membership Information Form
DATE
*
/
Month
/
Day
Year
Date
FELLOWSHIP FRIEND
Name
*
Last Name
First Name
Middle Name
CELL PHONE: ( )
*
Format: (000) 000-0000.
HOME PHONE: ( )
Please enter a valid phone number.
Format: (000) 000-0000.
DATE OF BIRTH
/
Month
/
Day
Year
Date
MARITAL STATUS:
*
Single
Married
Divorced
Widowed
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-MAIL
*
example@example.com
IF UNDER THE AGE OF 18, PLEASE LIST PARENT/GUARDIAN
PLEASE INDICATE YOUR ETHNIC ORIGIN BELOW:
*
Black/African American
Caucasian
Hispanic
Asian
Native American
Pacific Islander
Other
SPOUSE INFORMATION:
NAME
DATE OF MARRIAGE
/
Month
/
Day
Year
Date
DATE OF BIRTH
/
Month
/
Day
Year
Date
CELL PHONE: ( )
Format: (000) 000-0000.
E-MAIL
example@example.com
PLEASE INDICATE YOUR ETHNIC ORIGIN BELOW:
Black/African American
Caucasian
Hispanic
Asian
Native American
Pacific Islander
Other
CHILD(REN) NAME(S):
1.
Date
/
Month
/
Day
Year
Date
SEX
Please Select
Male
Female
2.
Date
/
Month
/
Day
Year
Date
SEX
Please Select
Male
Female
3.
Date
/
Month
/
Day
Year
Date
SEX
Please Select
Male
Female
4.
Date
/
Month
/
Day
Year
Date
SEX
Please Select
Male
Female
DATE OF BAPTISM
/
Month
/
Day
Year
Date
DATE OF CONFIRMATION
/
Month
/
Day
Year
Date
METHOD OF UNITING:
Confession
Transfer/Other UMC
Restored
Transfer Other Denomination
Affiliate (Maintaining membership in another UMC)
Associate (Maintaining membership in another denomination)
TRANSFER FROM (Church Name)
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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