Membership Information Questionnaire
Name (Last, First, Middle, Maiden) *
Your answer
Marital Status *
Date of birth *
MM
/
DD
/
YYYY
Birthplace *
Your answer
Home Address *
Your answer
Phone number *
Your answer
Is it OK to print phone number in the directory? *
Head of household email *
Your answer
Is it OK to print email in the directory? *
Cell phone if different from home phone
Your answer
Is it OK to print cell phone number in directory?
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