We are currently updating our member records. Please complete the following form as completely as possible. If you have any questions while you are filling it out, please call the church office at 251-9095. Thank you!

Household Name/Family Name:
Number of Children in the Household:
Home Address (including city and zip code):
Home Phone Number:

Select one: Head of Household
                 Spouse
                  Child
                 Other

Full Name (First, Middle, Last):
Preferred Name or Nickname: 

Work Phone: 
Cell Phone:    
Email:          
(Please check the best way to contact this person. If the home phone is the best method of contact, please check here .)

Most Recent Church Affiliation (if any) and Last Year of Active Involvement

Marital Status