Please enter the following information. If you are the head of household, please also fill out this form separately for any other church members in your household. For any fields you have in common (address, email address, phone number), you may enter "Same as -insert head of household name-", e.g. "Same as John Smith". If you do not know the information, just leave it blank. Thank you!

Your information will only be used for church purposes and will never be shared outside Emanuel.

Full Name:*

Phone Number (best number to contact you):*

Email Address:*

Full Address (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.

Birth Date & Place:

Baptismal Date & Place (if known):

Confirmation Date & Place (if known):

Wedding Anniversary Date (if applicable):

Current Occupation(s):