Membership Form

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Home Phone

(###)

###

####

Cell Phone *

(###)

###

####

Work Phone

(###)

###

####

Have you been baptized? *

Yes

No

If you were baptized, when were you baptized?

MM

DD

YYYY

Are you a member of an Episcopal church? *

Yes

No

Have you been confirmed? *

Yes

No

If you were confirmed, when were you confirmed?

MM

DD

YYYY

Marital Status *

Single

Married

Widowed

N/A

Wedding Date (if applicable)

MM

DD

YYYY

Spouse Name (if applicable)

First Name

Last Name

Spouse Date of Birth (if applicable)

MM

DD

YYYY

Spouse Phone Number (if applicable)

(###)

###

####

Is your spouse baptized? (if applicable)

Yes

No

If yes, when was your spouse baptized? (if applicable)

MM

DD

YYYY

Is your spouse a member of an Episcopal church? (if applicable)

Yes

No

Was spouse Confirmed? (if applicable)

Yes

No

When was your spouse confirmed? (if applicable)

MM

DD

YYYY

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

OK to send Emergency Contact SMS Text Messages?

Yes

No

Opportunities for Involvement

Altar Guild

Acolytes

Assisi Choir

Bell Choir

Lay Eucharistic Ministry

Lay Reader/Chalice Bearer

Outreach

Teaching Sunday School

Ushering

Youth Group

Areas of Interest

Arts/Crafts

Baking/Cooking

Bible Study

DIY/Repair Work

Gardening

Photography

Sports/Athletics

Technology

Child 1 Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Cell Phone

(###)

###

####

Baptized?

Yes

No

If yes, when was your child baptized?

MM

DD

YYYY

Child 2 Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Cell Phone

(###)

###

####

Baptized?

Yes

No

If yes, when was your child baptized?

MM

DD

YYYY

Child 3 Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Cell Phone

(###)

###

####

Baptized?

Yes

No

If yes, when was your child baptized?

MM

DD

YYYY