Church Membership
Personal Details
Title
Name
Your answer
Surname
Your answer
Address 1
Your answer
Address 2
Your answer
Postcode
Your answer
Phone
Your answer
Communications Preferences
Email
Your answer
Mobile
Your answer
Contact from ministry team by
Can share with others
Add to email news
Next of Kin
Emergency Contact Name
Your answer
Emergency Contact Number
Your answer
Electoral Roll
For inclusion on the ER, I am baptized and
ER qualification
Gift Aid Declaration
Gift Aid can be claimed by St Peter's
Signed
Signature Date
MM
/
DD
/
YYYY
Record added by
Misc.
On PCC
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