Church Member Information – United We All Can Stand

Please complete all applicable areas of this form. All information is confidential and will only be used for ministry appropriate events.

Use this form to submit your contact information or to update existing information.

Name

First

Last

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Marital Status:

Single
Married
Widowed

DOB:

Membership Date:

Address

Address Line 1

City

State

Zip Code

Spouses Name

Wedding Anniversary Date:

Occupation:

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Phone

Cell

EMERGENCY CONTACT INFORMATION

Emergency Contact

First

Last

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Numbers:

Relationship:

List those dependents that are living with you.

Dependents Name

First

Last

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DOB:

Membership Date:

Gender

Male
Female

Dependents Name

First

Last

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DOB:

Membership Date:

Gender

Male
Female

Dependents Name

First

Last

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DOB:

Membership Date:

Gender

Male
Female

Additional Comments: