FAMILY REGISTRATION FORM

ID / Env.#

Family Name
Head of Household*

PrefixFirst NameMiddle NameLast NameSuffix
Spouse*

PrefixFirst NameMiddle NameLast NameSuffix
Name formats used in mailings*

Mailing Name (ex: Mr. & Mrs. John Smith...)Informal Salutation (ex: John & Mary)Formal Salutation (ex: Mr. & Mrs. Smith)

Family Info
Registered*
Family Status*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Unlisted?*

YesNo
E-mail*
example@example.com

Mailing Address (if different than street address)
Mailing Address

Mailing Address 1

Mailing Address Line 2

CityState / Province

Postal / Zip CodeCountry

Alternate Address
Alternate Address

Alternate Address 1

Alternate Address Line 2

CityState / Province

Postal / Zip CodeCountry
Alternate Email
example@example.com
Send to Email instead of mail when possible?

YesNo
Active from

MonthDayYear
Date
to

MonthDayYear
Date
Alternate Address Remark
Remark
Should be Empty: