Church New Member Registration Form
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1
2Peace Lutheran Church
New Member Registration Form
HOUSEHOLD INFORMATION
Name (Mailing Label) :
Street Address:
City:
State:
Zip:
Home Phone: (
)
Is the above information publishable in the church directory? Yes or No / Would you like weekly giving envelopes? Yes No
What or who brought you to Peace?
Would you like a mailbox? Yes or No
If yes, In the Narthex at FRONT or ConneXions Center in BACK (circle one)
Would you like to receive Peace2U, our email newsletter?
Yes or
No
Are you Transferring Membership from anther Church? If yes, Church/City/State
INDIVIDUAL FAMILY MEMBERS (Adults)
Last Name:
Baptized (mm/dd/yyyy) :
First Name:
Where (church/city/state):
Preferred First Name if different:
Confirmed (mm/dd/yyyy):
Middle Name:
Where (church/city/state):
Cell Number:
Email Primary:
Work Number:
Email Secondary:
Sex: (circle one)
Male or Female
Occupation:
Date of Birth: mm/dd/yyyy
Employer:
Birthplace (city/state):
Marital Status: (circle one)
Single
Married
Emergency Contact :
Widowed
Divorced
Relationship to Individual:
Marriage Date:
Phone Number: (
)
Maiden Name:
INDIVIDUAL FAMILY MEMBERS (Adults)
Last Name:
Baptized (mm/dd/yyyy) :
First Name:
Where (church/city/state):
Preferred First Name if different:
Confirmed (mm/dd/yyyy):
Middle Name:
Where (church/city/state):
Cell Number:
Email Primary:
Work Number:
Email Secondary:
Sex: (circle one)
Male or Female
Occupation:
Date of Birth: mm/dd/yyyy
Employer:
Birthplace (city/state):
Marital Status: (circle one)
Single
Married
Emergency Contact :
Widowed
Divorced
Relationship to Individual:
Marriage Date:
Phone Number: (
)
Maiden Name:
CHILDREN ON BACK
Office use: CW Entry ________ Hard Copy _________ Env/Status ___________ Mailbox __________ Transfer _________ Membership Date ___________
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Parent category: Business