Church Records Update 2021
Please complete the following questions to the fullest of your ability.
Please complete one form per adult.
Last Name *
First Name *
Street Address *
City, State, Zip *
Home Phone Number
Cell Phone Number
Email Address
Birthday *
MM
/
DD
/
YYYY
Martial Status
Clear selection
Wedding Anniversary
MM
/
DD
/
YYYY
Name of Spouse
Children under the age of 18 and their birthdays.
Would you like to receive the monthly Bern Bugle Newsletter *
Would you like to receive the Weekly "Tuesday Prayers" & Home Worship Ideas? *
What information may we publish in our Church Directory? (check all the apply) *
Required
Emergency Contact (optional)
Please share with us who you like contacted in the event of an emergency.
Name of Emergency Contact
Relationship of Emergency Contact
Emergency Contact's Home Phone Number
Emergency Contact's Cell Phone Number
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