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LAST NAME_____________________________________ MAILING TITLE: Miss / Ms. / Mr. / Mrs. / Mr. & Mrs. FIRST NAME ______________________________
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STREET / P.O. BOX # ___________________________________ APT. # __________ ZIP CODE ______________ PHONE__________________ UNL ?______
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DATE REGISTERED _____________________________________ ID # _________________ FORMER PARISH ______________________________________
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DO YOU WANT TO BE INCLUDED THE PARISH DIRECTORY? ___ YES ___ NO DO YOU WANT TO RECEIVE THE ST. LOUIS REVIEW ___YES ___ NO
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PLEASE CONTACT ME ABOUT: PRESCHOOL/SCHOOL_______ PARISH SCHOOL OF RELIGION_______ RITE OF CHRISTIAN INIATION OF ADULTS_______
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MEMBER TYPEHEAD OF HOUSEHOLDSPOUSECHILDCHILDCHILDOTHER
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FIRST NAME
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PREFERRED NAME
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MAIDEN/LAST NAME
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TITLE
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MARITAL STATUS
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MARRIED BY PRIEST Y N
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CHURCH OF MARR.
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BIRTH DATE _____/_____/_____ _____/_____/_____ _____/_____/_____ _____/_____/_____ _____/_____/_____ ____/_____/_____
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SEX MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALEMALE FEMALE MALE FEMALE
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RELIGION
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PRACTICING FAITH Y N Y N Y N Y N Y N Y N
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 PLEASE PROVIDE DATES IF KNOWN
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BAPTIZED Y N Y N Y N Y N Y N Y N
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CONVERT Y N Y N Y N Y N Y N Y N
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FIRST COMMUNION Y N Y N Y N Y N Y N Y N
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CONFIRMED Y N Y N Y N Y N Y N Y N
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MARRIAGE Y N ____/____/____ Y N ____/____/____ Y N ____/____/____ Y N ____/____/____Y N ___/____/___Y N___/____/____
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MEMBER TYPEHEAD OF HOUSEHOLDSPOUSECHILDCHILDCHILDOTHER
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OCCUPATION
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EMPLOYER
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WORK PHONE
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CELL PHONE
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EMAIL ADDRESS
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DO YOU HAVE ANY SPECIAL NEEDS OR TALENTS?
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