Registration
Membership Information Date__________
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Head of Household |
Spouse |
Title: (Circle one) |
Mr. Mrs. Miss. Ms. Dr. Rev. Other _____ |
Mr. Mrs. Miss. Ms. Dr. Rev. Other ______ |
Name: First-Middle (Maiden) Last |
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Preferred name |
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Birthday: |
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Marital Status: |
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Anniversary Date: |
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Address: City, State / Zip |
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Home Phone: |
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Cell Phone: |
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Work Phone |
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Fax #: |
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Occupation: |
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Employer: |
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Date joined parish |
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Religious Background |
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Baptized: |
yes o no o Date: |
yes o no o Date: |
Children living at home
Name: First Middle and Last |
Birth Date |
Baptized |
Grade |
School |
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yes o Date: |
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yes o Date: |
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yes o Date: |
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yes o Date: |
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yes o Date: |
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yes o Date: |
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