Emanuel Lutheran Church - Member Info Form

Please provide the most convenient phone number for us to reach you at.*

Please provide the most convenient email address for us to reach you at.*

Please enter the full address for your household (street address, city, state, zip code).*

How would you like for us to address mailings to the household? "Mr. & Mrs. Smith", "Jack & Jill Smith", "Smith Family", etc.

Please list the first and last names of each member of your household.

Please provide the birth dates and birth places for each member of your household.

Please provide the baptismal date for each member of your household, if known.

Please provide the confirmation date for each member of your household, if known.

Please provide your wedding anniversary date, if applicable.

Please provide the current occupation(s) for each member of your household.

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Member Info Form