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St. Mary's Parish REGISTRATION
FOR CHURCH MEMBERSHIP
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*
Spouse Phone Number: *
Spouse Occupation:
Spouse Date of Birth & Country:
Children/Dependents #1:

Please include:
Name; Date of Birth/Country; Student or Occupation; Baptismal Date and Location
Children/Dependents #2:

Please include:
Name; Date of Birth/Country; Student or Occupation; Baptismal Date and Location
Children/Dependents #3:

Please include:
Name; Date of Birth/Country; Student or Occupation; Baptismal Date and Location
Children/Dependents #4:

Please include:
Name; Date of Birth/Country; Student or Occupation; Baptismal Date and Location
Donation:
$200
 *
How Often? *
Required
Payment Method:

 *
Required
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Credit Card Information (if applicable)

Please include:
CC#; Expiration Date; Three Digit Number; and Billing Address (if different than above)
Bank Information (if applicable):

Please include:
Bank Name; Routing Number; and Account Number
(Office Use Only)
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