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Immanuel Directory
Please fill out a separate form for each adult in your household.
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Last Name
*
Your answer
First Name
*
Your answer
Mailing Address (street, city, state and zip)
*
Your answer
Phone Number (include area code with dashes)
*
Your answer
Email Address
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Wedding Anniversary (if applicable)
MM
/
DD
/
YYYY
Names of Children Living at Home with birth dates (if applicable)
Your answer
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