Membership Form
To insure we have the most current contact information for you, please complete the form below. There is a place at the bottom to select secretariat membership. Couples, each individual must complete this form. Upon completion, a link will appear if you need to submit for a second person.
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First Name *
Last Name *
Email - In an effort to be more environmentally and fiscally responsible, please enter an email so we can communicate electronically as much as possible.
Currently, we are communicating via website, Facebook and email. If you prefer postal mail, please check this box so that can be honored.
Street Address, City, Zip *
Preferred phone number *
Alternative phone number
Church and town of church
I would like to volunteer my time and/or talents in some way to help. Please check any boxes that apply.
I hereby signify that I wish to switch my secretariat membership to Ignite Via de Cristo.  The secretariat I am currently with is: *
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