CUMC Information Update
Please complete this form so that we can update our member/visitor records
Family Mailing Label *
ie: Mr. & Mrs. Smith, Mrs. Bob Smith, Mrs. Sue Smith, Dr. Bob Smith, Bob & Sue Smith
Your answer
Family Home Address *
Address, City, State, Zip Code
Your answer
Home Phone *
Your answer
First Name *
Your answer
Nickname
Your answer
Last Name *
Your answer
Email Address *
Your answer
Cell Phone
Your answer
Family Relation *
Gender *
Birthdate *
MM
/
DD
/
YYYY
Marital Status *
Marriage Date
MM
/
DD
/
YYYY
Is there a second adult in your household? *
If there is not another adult in your household please continue on to the next question.
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