NEW MEMBER FORM - St. Mary

FAMILY NAME (last name)

Address

Street Address

Street Address Line 2

CityState

Zip Code

Home Phone

Email

example@example.com

Date Family Joined Parish

Date

Parish Belonged to Previously

Adult #1:

First NameMiddle NameLast NameMaiden Name (if applicable)

Date of Birth

Date

Religion

Church baptized in:

Date of baptism:

Date

Church confirmed at:

If not Catholic

I would like to be considered for RCIAI am not interested in RCIA at this time

EDUCATION:
# of yearsyears of HIGH SCHOOL
# of yearsyears of VOCATIONAL/TECHNICAL SCHOOL
# of yearsyears of COLLEGE

Occupation

Place of Employment

Adult #2

First NameMiddle NameLast NameMaiden Name (if applicable)

Date of Birth

Date

Religion

Church baptized in:

Date of baptism

Church confirmed at:

If not Catholic

I would like to be considered for RCIAI am not interested in RCIA at this time

EDUCATION:
# of years years of HIGH SCHOOL
# of years years of VOCATIONAL/TECHNICAL SCHOOL
# of years years of COLLEGE

Occupation

Place of Employment

Marital Status:

Date of Wedding

Married by

Name of priest/pastor

Location of Wedding

Church or Building

Street Address Line 2

CityState

St. Mary of the Immaculate Conception