Pine Island United Methodist Church Member & Friends Contact Information
Please help us by filling in your address and contact information and submit. We are rebuilding our database and church management system so that we can communicate with you in a much more effective manner.
Thanks so much for your help!
Email address *
Gender
Clear selection
Full Name *
Preferred Name *
Address *
road, city, state, zip code
Alternate Address
Please note, if you have a P.O. box, use the ALTERNATE ADDRESS to kindly provide your physical address.
Date of Birth *
MM
/
DD
/
YYYY
Marital Status *
Wedding Anniversary Date *
MM
/
DD
/
YYYY
Children Living at Home
Names & Date of birth
Baptized
Clear selection
Member of PIUMC?
Clear selection
Do You Attend Worship Regularly?
Clear selection
Home Phone
Cell Phone
Work Phone
Other Email
Employer
Occupation
Retired
Clear selection
Preferred Method of Contact *
Do You Attend a Small Group ?
A group that helps to enhance your spiritual growth and relationship with Jesus, does not have to be a group that meets regularly at PIUMC ?
Additional notes
anything extra you might want to include.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy