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!
* Required
Email address
*
Your email
Gender
Male
Female
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Full Name
*
Your answer
Preferred Name
*
Your answer
Address
*
road, city, state, zip code
Your answer
Alternate Address
Please note, if you have a P.O. box, use the ALTERNATE ADDRESS to kindly provide your physical address.
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Marital Status
*
Married
Single
Widow
Other:
Wedding Anniversary Date
*
MM
/
DD
/
YYYY
Children Living at Home
Names & Date of birth
Your answer
Baptized
Yes
No
Would like to be Baptized
Clear selection
Member of PIUMC?
Yes
No
Would like to become a member
Clear selection
Do You Attend Worship Regularly?
Yes
No
Occasionally
As Visitor
Other:
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Home Phone
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Other Email
Your answer
Employer
Your answer
Occupation
Your answer
Retired
Yes
No
Clear selection
Preferred Method of Contact
*
Home Phone
Cell Phone
Text
Email
Address
Secondary Address
Any/All
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 ?
Your answer
Additional notes
anything extra you might want to include.
Your answer
Send me a copy of my responses.
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