St. John's Membership Review 2021
Please take a moment to fill out the form below to help facilitate the completion of the review process. If you have any questions, please call the church office at 815-625-2634 or email office@stjohnsonthird.org

Thank you for your time and support as we strive to be about the building up of God's Kingdom through Christ's mercy and grace.
Email *
SECTION 1: General Information
Their descendants shall be known among the nations, and their offspring among the peoples; all who see them shall acknowledge that they are a people whom the Lord has blessed. - Isaiah 61:9, NRSV
Full Name *
Full Name of Spouse
Have you or your spouse changed your name? If so, please list previous name(s) below including maiden name(s).
Please list any dependents currently living at your address.
Please provide your current address including City, State, Zip Code, and Phone Number *
Is there another phone number you use, or would your spouse like their number on file?
Do you currently live in an assisted living facility or consider yourself homebound? *
If you answered yes above, please provide information on your emergency contact for pastoral care needs including names, phone numbers, and email addresses.
Are you a snowbird or sunbird and spend one or more seasons of the year in a different city or state? *
For snowbirds/sunbirds -please provide your alternative address used while you are out of the area including Street, City, State and Zip Code.
For snowbirds/sunbirds -is there a congregation that you have an associate membership with while you are out of the area?
Clear selection
If yes, please provide the information for that congregation you hold an associate membership with including the Congregation Name, Street, City, State and Zip Code along with the Phone Number and E-Mail if applicable.
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