KUMC Contact Information

KUMC Contact Information

Please complete the form below for church use
If you are a member of KUMC or someone who attends here on a regular basis, please complete a form for EACH person in your home and/or those in your family who are still members but may live away from here.
Name*

First NameLast Name
Preferred Name
Email*
example@example.com
Phone Number:
Cell Phone Number:
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Birth Date:

MonthDayYear
Gender

MaleFemale
Occupation
Employer
Retired?

NoYes
Education
School
Membership

MemberRegular AttenderVisitorFirst Time Visitor
Can we contact you?

LetterE-MailPhone CallTextVisit
Anniversary Date:

MonthDayYear
Family Name
Spouse's Name

First NameLast Name
Children's names
Should be Empty: