St. Stephen's Membership Information Form
The purpose of this form is to collect information for our church's membership database.

This information will be kept confidential and will not be shared with anyone outside of St. Stephen's pastoral, school or office staff. It will be used to help us serve you, and to learn what areas we may ask you to help your congregation

Fields for title, name, address and permission to publish directory information are required.

Title *
Mr.
Mrs.
Miss
Ms.
Dr.
Rev.
Row 1
Name: First, Middle, (Maiden name), Last *
Your answer
Preferred name or nickname
Your answer
Address *
Your answer
Alternate Address (College or winter address). Please include time (Example: "at 1313 Mockingbird Lane, Los Angeles, California 90047 from December 1 through April 30")
Your answer
Birth Date
MM
/
DD
/
YYYY
Birth Place
Your answer
Marital Status
Single
Married
Divorced
Widowed
Row 1
Wedding Date
MM
/
DD
/
YYYY
Wedding Place: Church, City, State
Your answer
Baptism Date
MM
/
DD
/
YYYY
Baptism Place: Church, City, State
Your answer
Confirmation Date
MM
/
DD
/
YYYY
Confirmation Place: Church, City, State
Your answer
Other Church Background (optional)
Your answer
How did you join St. Stephen's
Baptized at St. Stephen's
Confirmed at St. Stephen's as child/teenager
Confirmed at St. Stephen's as an adult (after taking a Bible Information or Adult Catechism Class)
Transfer from another WELS congregation
Profession of faith (reinstated into membership, or received into membership after a short interview with a pastor)
Row 1
Father's name: First, Middle, Last
Your answer
Mother's name: First, Middle, (Maiden) Last
Your answer
Spouse
Your answer
Home Phone
Your answer
Cell phone
Your answer
Can your cell phone receive texts?
Yes
No
Row 1
Work phone
Your answer
Are you permitted to receive calls at work?
Yes
No
Row 1
Email address *
Your answer
Second email address (optional)
Your answer
May we include your address, phone and email in a directory? *
Yes
No
Row 1
Occupation(s)
Your answer
Employer(s)
Your answer
Children (List here, but please fill out form again for each child living at home)
Your answer
Skills
Leadership
Activites
Spiritual or Other Gifts
Willing to Serve
Submit
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