Bethel Lutheran Church                                           New Member Adult Registration
Each adult (age 18 and older) in the family completes a separate form.  If you can not answer a response, please enter with NA.  Thank you
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First Name: *
Middle Name: *
Last Name: *
Maiden Name: *
Address (Street, Apt #): *
City: *
Zip Code: *
Home Phone: *
Cell Phone: *
Work Phone:
Email Address: *
Birthdate: *
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City/State of Birth: *
Religious Background: *
Required
Have You Been Baptized? *
If Yes, Date of Baptism:
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DD
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Church, City/State of Baptism: *
Have You Been Confirmed/Affirmed in the Lutheran Faith? *
If Yes, Date of Confirmation:
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DD
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Confirmed Church, City and State: *
Most Recent Church Membership (Church Name, City and State): *
Have You Ever Been a Member of Bethel Before? *
If Yes, Under What Name?
Service I Attend Most Often? *
Required
Marital Status: *
Name of Spouse and/or Fiance':
Date of Marriage:
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DD
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YYYY
Church City/State of Marriage:
Father's Name: *
Mother's Name: *
Present Occupation: *
Present Employer: *
What/Who First Brought You to Bethel Lutheran Church? *
Why Did You Choose Bethel Lutheran? *
Do You Have Any Relatives Who Are Members of Bethel? *
If Yes, Please List Names/Your Relationship to Them:
In Case of Emergency, Please Contact the Following (List two people and their phone numbers): *
Please List All Children (Including Adult Children) Whether Joining Bethel or Not: *
I Plan to Attend the New Member Orientation 101 Class on: *
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