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Bethel Lutheran Church New Member Adult Registration
Each adult (age 18 and older) in the family completes a separate form. If you can not answer a response, please enter with NA. Thank you
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* Indicates required question
First Name:
*
Your answer
Middle Name:
*
Your answer
Last Name:
*
Your answer
Maiden Name:
Your answer
Address (Street, Apt #):
*
Your answer
City:
*
Your answer
Zip Code:
*
Your answer
Home Phone:
*
Your answer
Cell Phone:
*
Your answer
Work Phone:
Your answer
Email Address:
*
Your answer
Birthdate:
*
MM
/
DD
/
YYYY
City/State of Birth:
*
Your answer
Religious Background:
*
Lutheran
Catholic
Methodist
Baptist
Unitarian
Other
Required
Have You Been Baptized?
*
Yes
No
If Yes, Date of Baptism:
MM
/
DD
/
YYYY
Church, City/State of Baptism:
Your answer
Have You Been Confirmed/Affirmed in the Lutheran Faith?
*
Yes
No
If Yes, Date of Confirmation:
MM
/
DD
/
YYYY
Confirmed Church, City and State:
Your answer
Most Recent Church Membership (Church Name, City and State):
*
Your answer
Have You Ever Been a Member of Bethel Before?
*
Yes
No
If Yes, Under What Name?
Your answer
Service I Attend Most Often?
*
Saturday 6pm
Sunday 9am
Sunday 10:10am Gate of Life
Sunday 10:30am
Required
Marital Status:
*
Single
Married
Divorced
Widow
Name of Spouse and/or Fiance':
Your answer
Date of Marriage:
MM
/
DD
/
YYYY
Church City/State of Marriage:
Your answer
Father's Name:
*
Your answer
Mother's Name:
*
Your answer
Present Occupation:
*
Your answer
Present Employer:
*
Your answer
What/Who First Brought You to Bethel Lutheran Church?
*
Your answer
Why Did You Choose Bethel Lutheran?
*
Your answer
Do You Have Any Relatives Who Are Members of Bethel?
*
Yes
No
If Yes, Please List Names/Your Relationship to Them:
Your answer
In Case of Emergency, Please Contact the Following (List two people and their phone numbers):
*
Your answer
Please List All Children (Including Adult Children) Whether Joining Bethel or Not:
*
Your answer
I Plan to Attend the New Member Orientation 101 Class on: *
*
Wednesday, May 21 at 6pm via video conference (registration closes on May 14)
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