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Name*
Preferred Name*
Let us know what name you would preferred us to use
, AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
If different from mailing
mobile phone( ) -
home phone( ) -
Email*
Birthday* January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901
Beyond the basics
Let us know a little bit more about you so we can help you get connected!
Place of employment, position
Let us know where you work.
single
married
partnered, committed relationship
widowed
divorced
Hobbies or special interests
Do you have any special talents, abilities or professional skills which you'd be willing to use periodically in our ministry together?
for example: bookkeeping, human resources, teaching, building repair, etc.
Family
If you are joining with your immediate family, this information helps us connect you in our database. it's not uncommon for people to join our church while their spouse and/or children do not join. But we'd love to know a bit more about them so that we can support you.
Spouse's preferred name
Spouse's Phone Number( ) -
We will only use this in case of emergency or urgent need.
Spouse's Email
Spouse's Birthday January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901
Spouse's Church Affiliation
church name, city, state - if applicable
Child 1 Information
First name Last name, birthdate, grade in school
lives with you
baptized
confirmed (to full church membership)
Child 2 information
Child 3 Information
Child 4 information
Child 5 Information
Child 6+
yay for big families! you know the drill by now, Name, birthday, grade, lives w/you, baptized, confirmed
Special needs or concerns?
Please indicate any special needs, circumstance, or concerns for you and your family.
Previous Church Membership
If this is your first time to join a church, welcome! (and feel free to skip this section).If it's been a while since you've attended a church (10+ years), this may or may not be helpful. Use your judgement.
If you are currently a member of another church, we'd like to let them know you've found a new church home. Let us know how you were involved in your previous church, and especially if you've been ordained as an Elder or Deacon in the PC(USA) because these ordinations transfer to your new church.
yes
no
maybe?
Previous church membership
church name, city, state
Previous church activities
how were you involved in your last congregation?
PC(USA) Ordination - Elder
approximate date ordained, church name, city, state
PC(USA) Ordination - Deacon
Ordination - other denomination
Title, date ordained, church name, city, state
Contact Preferences
email (weekly)
postal service (monthly)
Home
Mobile
no thank you
emergencies only
We have an "all call" on most Thursday with updates from the church. Under 2 mins. Goes to mobile phone number.
mornings
afternoons
evenings
before church
after church