STSMCC Detroit Registration Form

New Member Registration Form

17235 Mount Vernon Street, Southfield MI 48075
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Family Name
Hometown in Kerala
YesNo
Spouse's Name*

First NameLast Name
Spouse's Email
example@example.com
Spouse's Family Name*
Spouse's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Spouse's Hometown in Kerala
YesNo
Household Family Details*
"Members are encouraged to contribute a monthly offertory of $100, which amounts to $1,200 per year. At the time of registration, an initial contribution of $250 is recommended and will be credited toward the annual offertory."
Signature*

Clear
- Pastor Approval
- Registration Department
- Should be Empty:

New Member Registration Form