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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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First Name:    *
Middle Name:  
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Last Name:  
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Maiden Name:  
Address (Street, Apt #):  
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  City:  
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  Zip Code:  
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  Home Phone:  
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  Cell Phone:  
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  Work Phone:   
  Email Address:  
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  Birthdate:  
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DD
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YYYY
  City/State of Birth:  
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  Religious Background:  
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Required
  Have You Been Baptized?  
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If Yes, Date of Baptism:  
MM
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DD
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YYYY
Church, City/State of Baptism:   
Have You Been Confirmed/Affirmed in the Lutheran Faith?  
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  If Yes, Date of Confirmation:  
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DD
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Confirmed Church, City and State:  
Most Recent Church Membership (Church Name, City and State):  
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  Have You Ever Been a Member of Bethel Before?  
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  If Yes, Under What Name?  
Service I Attend Most Often?  
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Required
Marital Status:  
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Name of Spouse and/or Fiance':  
Date of Marriage:  
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DD
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YYYY
Church City/State of Marriage:  
Father's Name:  
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Mother's Name:  
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Present Occupation:  
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Present Employer:  
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What/Who First Brought You to Bethel Lutheran Church?  
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Why Did You Choose Bethel Lutheran?  
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Do You Have Any Relatives Who Are Members of Bethel?  
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If Yes, Please List Names/Your Relationship to Them:  
In Case of Emergency, Please Contact the Following (List two people and their phone numbers):  
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Please List All Children (Including Adult Children) Whether Joining Bethel or Not:  
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I Plan to Attend the New Member Orientation 101 Class on: *  

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