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Membership - Data Form

Please complete all applicable fields. Your information is kept confidential.

Personal Information

Birth Date
Have You Been Baptized?
Approx. Baptism Date

Address

I am...
Anniversary Date

If Married, Spouse's Personal Information

Birth Date
Has Your Spouse Been Baptized?
Spouse's Approx. Baptism Date

Spouse's Address

Child(ren) living with parent(s):

First Child
Birth Date
Baptism Date (If Applicable)
Second Child
Birth Date
Baptism Date (If Applicable)
Third Child
Birth Date
Baptism Date (If Applicable)
Fourth Child
Birth Date
Baptism Date (If Applicable)
Are you transferring from another Episcopal Church?
If Yes, please fill this up:
Would you like St. Mary's to request a letter of transfer from your previous church?

Address Of Church

Please list family members (including yourself) who have been confirmed:
Have any of you been received into the Episcopal church by a Bishop?
Which St. Mary's service do you usually attend?
Ministry Interests (I/we are interested in the following ministry areas:)
Is there any additional information or comment(s) you would like to provide?