Church Registration adult

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Previous Parish Please enter valid data.

First Name REQUIRED Please fill out this field. Please enter valid data.

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Street Address REQUIRED Please fill out this field. Please enter valid data.

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State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number

Please include area code: xxx-xxx-xxxx

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Sacraments Received Baptized First Eucharist Confirmation

Occupation Please enter valid data.

Birth Date REQUIRED

mm/dd/yy

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Martial Status REQUIRED Single Diovorced Married Please fill out this field.

Sex REQUIRED Male Female Please fill out this field.

****** Spouses Information if Married *****

First Name Please enter valid data.

Last Name Please enter valid data.

Sex Male Female

Occupation Please enter valid data.

Birth Date REQUIRED

mm/dd/yy

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Sacraments Received Baptized First Eucharist Confirmation

***** Other information *****

Ministries that would like to serve on. Lector Usher Eucharistic Minister Knights of Columbus Ladies Guild

Do You want church Envelopes REQUIRED yes no Please fill out this field.

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St. Mildred Catholic Church