New Member Information Form
Adult 1
First/Middle Name *
Your answer
Last Name *
Your answer
Preferred Name (ex. Mike for Michael)
Your answer
Gender *
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home/Primary Phone Number *
Your answer
Work Phone Number
Your answer
Cell Phone Number
Your answer
Email Address *
Your answer
Employer
Your answer
Occupation
Your answer
Birth Date *
MM
/
DD
/
YYYY
Have you been baptized? *
Baptism Date and Location, if known
Your answer
Have you been confirmed? *
Confirmation Date, Church Name and Location, if known
Your answer
If married but your spouse is NOT joining Prince of Peace, please provide their name
Your answer
Your maiden name, if applicable
Your answer
Former Church Name
Your answer
Former Church Address
Your answer
May Prince of Peace notify church and request transfer records?
Adult 2
First/Middle Name
Your answer
Last Name
Your answer
Preferred Name
Your answer
Gender
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Home/Primary Phone Number
Your answer
Work Phone Number
Your answer
Cell Phone Number
Your answer
Email Address
Your answer
Employer
Your answer
Occupation
Your answer
Birth Date
MM
/
DD
/
YYYY
Have you been baptized?
Baptism Date and Location, if known
Your answer
Have you been confirmed?
Confirmation Date, Church Name and Location, if known
Your answer
Your maiden name, if applicable
Your answer
Former Church Name
Your answer
Former Church Address
Your answer
May Prince of Peace notify church and request transfer records?
Child #1
Child #1 First/Middle/Last Name
Your answer
Gender
Birth Date
MM
/
DD
/
YYYY
Baptized?
Baptism Date
MM
/
DD
/
YYYY
Baptism Church Name and Address
Your answer
Child #2
Child #2 First/Middle/Last Name
Your answer
Gender
Birth Date
MM
/
DD
/
YYYY
Baptized?
Baptism Date
MM
/
DD
/
YYYY
Baptism Church Name and Address
Your answer
Child #3
Child #3 First/Middle/Last Name
Your answer
Gender
Birth Date
MM
/
DD
/
YYYY
Baptized?
Baptism Date
MM
/
DD
/
YYYY
Baptism Church Name and Address
Your answer
Child #4
Child #4 First/Middle/Last Name
Your answer
Gender
Birth Date
MM
/
DD
/
YYYY
Baptized?
Baptism Date
MM
/
DD
/
YYYY
Baptism Church Name and Address
Your answer
Almost Done!
Would you like to receive the Prince of Peace weekly update delivered via email? *
How did you hear about Prince of Peace? *
Your answer
Would you like to visit with a staff member? *
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