Form
Name
*
First Name
Last Name
Birthdate (Month and Day Only)
Month
Day
Spouse's Name
First Name
Last Name
Spouse's Birthdate (Month and Day Only)
Month
Day
Anniversary
Month and Day
Year
Back
Next
Children (If Applicable and Living in the Same Household)
Back
Next
Primary Phone Number - This will be added to the 2023 Directory
*
Home or Cell Phone Preferred
Type of Phone
Home
Cell
Work
Other
Secondary Phone Number
Home or Cell Phone Preferred
Type of Phone
Home
Cell
Work
Other
Primary Email Address
*
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Next
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Submit
Should be Empty:
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