Nickname (Preferred to be called name) if different from Name
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Street Address *
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City *
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State *
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Zip Code *
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Cell Phone with area code
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Home Phone with area code
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Preferred phone *
Date of Birth *
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We often take photographs of activities and events. These photos may be displayed on the church's website, Facebook page, T.W.I.R.P., bulletin board or local newspapers. We will not publicize photos of you or your children without your consent. *
Spouse/Civil Union/Partner Name
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Anniversary Date
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DD
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Do you have children under age 18 to include in your listing? *