St. Benedict the Moor Catholic Church New Member Registration Form
Welcome to St. Benedict the Moor Parish. In seeking the needs of our Church members and Community, we ask that you complete the registration form and place it in the offering basket or return it through the mail 519 Liscum Drive, Dayton OH 45417 or Fax 937-268-6698
First Name
Your answer
Last Name
Your answer
Address
Your answer
Date of Birth
Your answer
Email
Your answer
Phone Number
Your answer
Spouse First Name
Your answer
Spouse Last Name
Your answer
Address
Your answer
Date of Birth
Your answer
Email
Your answer
Phone Number
Your answer
Child’s Name
Your answer
First Communion
Confirmation
Child’s Name
Your answer
First Communion
Confirmation
Child’s Name
Your answer
First Communion
Confirmation
Child’s Name
Your answer
First Communion
Confirmation
Child’s Name
Your answer
First Communion
Confirmation
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