Membership Information Form

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Title *

Last Name *

First Name *

Middle Name

Suffix

Nickname

Physical Address House Number *

Physical Address Street *

City *

State *

Zip *

Gender *

Female

Male

Birthdate *

YYYY

Position in Household *

Maiden name

Marital Status *

Marriage Date

YYYY

Spouse's Complete (maiden) name:

Father's Complete Name: *

Mother's Complete Name: *

Baptized? *

Yes

Date of Baptism

YYYY

Place of baptism (church, city, state)

Confirmed? *

Yes

Date of Confirmation

YYYY

Place of Confirmation (church, city, state)

Phone Number *

Landline or Mobile? *

Landline

Mobile

Would you like to opt in for text message updates from Faith? (emergency updates, closures, breaking news, etc.) *

Yes

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This form was created inside of Faith Ev. Lutheran Church and School.

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