Member Information Update Form

NEW HORIZONS CHURCH / Member Information Update Form
Today's Date

MonthDayYear
Date
Please Provide Previous Information Below
Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
(Previous) Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(Previous) Home Phone
(Previous) Work Phone
(Previous) Cell Phone
(Previous) Email
example@example.com
Please Provide New Updated Information Below
(Current) Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(Current) Home Phone
(Current) Work Phone
(Current) Cell Phone
(Current) Email
example@example.com
Other Members of Your Household for Whom This Change Applies
(Member #1) Name

First NameMiddle NameLast Name
(Member #1) Date of Birth

MonthDayYear
Date
(Member #1) Relationship to you

SpouseChildOther
(Member #2) Name

First NameMiddle NameLast Name
(Member #2) Date of Birth

MonthDayYear
Date
(Member #2) Relationship to you

SpouseChildOther
Should be Empty: