MEMBER REGISTRATION FORM

Member Registration Form

Member Details
Full Name *

PrefixFirst NameMiddle NameLast NameSuffix
Name Formats used in Mailings*

Mailing Name (ex: Mr. John Smith)Informal Salutation (ex: John)Formal Salutation (ex: Mr. Smith)
Maiden & Nick Names*

Maiden NameNick Name

Personal
Date of Birth*

MonthDayYear
Marital Status*
Relationship*
(Type: Head / Spouse / Adult / Young Adult / Child / Other...)
Gender*

MaleFemale
Grade / Degree*
Language*
Ethnicity*
Religion*
Handicap*
Occupation*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Receives Separate Statement*

YesNo
Location (if Yes)*

Phone and Email
Phone Number*
Please enter a valid phone number.
Unlisted?*

YesNo
Another Phone Number
Please enter a valid phone number.
Unlisted?

YesNo
Email*
example@example.com
Remark

Sacraments
Birth Place*
Father Name*

First NameMiddle NameLast Name
Mother Name*

First NameMiddle NameLast Name
Mother Maiden's Name*

Baptism
Baptismal Name*
Date*

MonthDayYear
Date
Status: Approximate?*

YesNoUnsure
Performed by*
Church Name*
Churh's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sponsor*

First Communion
Extra Info*
Date*

MonthDayYear
Date
Status: Approximate?*

YesNoUnsure
Performed by*
Church Name*
Church's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sponsors*

Confirmation
Confirmation Name*
Date*

MonthDayYear
Date
Status: Approximate?*

YesNoUnsure
Performed by*
Church Name*
Church's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sponsor*

Marriage
Spouse Name*
Wedding Date*

MonthDayYear
Date
Status: Approximate?*

YesNoUnsure
Performed by*
Church Name*
Church's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sponsor*

Penance
Extra Info*
Date*

MonthDayYear
Date
Performed by*
Church Name*
Church's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Witness(es)*
Type a question*

Talents
I would like to volunteer the following skills

Ministries
I would like to volunteer for the following ministries
Should be Empty: