St. Stephen's Membership Information Form
The purpose of this form is to collect information for our church's membership database.

This information will be kept confidential and will not be shared with anyone outside of St. Stephen's pastoral, school or office staff. It will be used to help us serve you, and to learn what areas we may ask you to help your congregation

Fields for title, name, address and permission to publish directory information are required.
Title
Mr.
Mrs.
Miss
Ms.
Dr.
Rev.
(Never Use a Title)
Row 1
Clear selection
Name: First, Middle, (Maiden name), Last *
Preferred name or nickname
Address *
Alternate Address (College or winter address). Please include time (Example: "at 1313 Mockingbird Lane, Los Angeles, California 90047 from December 1 through April 30")
Birth Date
MM
/
DD
/
YYYY
Birth Place
Marital Status
Single
Married
Divorced
Widowed
Row 1
Clear selection
Wedding Date
MM
/
DD
/
YYYY
Wedding Place: Church, City, State
Baptism Date
MM
/
DD
/
YYYY
Baptism Place: Church, City, State
Confirmation Date
MM
/
DD
/
YYYY
Confirmation Place: Church, City, State
Other Church Background (optional)
How did you join St. Stephen's
Baptized at St. Stephen's
Confirmed at St. Stephen's as child/teenager
Confirmed at St. Stephen's as an adult (after taking a Bible Information or Adult Catechism Class)
Transfer from another WELS congregation
Profession of faith (reinstated into membership, or received into membership after a short interview with a pastor)
Row 1
Clear selection
Father's name: First, Middle, Last
Mother's name: First, Middle, (Maiden) Last
Spouse
Home Phone
Cell phone
Can your cell phone receive texts?
Yes
No
Row 1
Clear selection
Work phone
Are you permitted to receive calls at work?
Yes
No
Row 1
Clear selection
Email address *
Second email address (optional)
May we include your address, phone and email in a directory? *
Yes
No
Row 1
Occupation(s)
Employer(s)
Children (List here, but please fill out form again for each child living at home)
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