ST. PETER'S EPISCOPAL CHURCH MEMBERSHIP FORM

Name: *

Email Address: *

I have attended Cursillo: *

Date of Birth: *

Place of Birth:

Phone:

Address: *

City: *

State: *

ZIP Code: *

Baptism Date:

Denomination of Baptism:

Place of Baptism:

Would you like to become a member of St. Peter's Church? *

Request my Letter of Transfer?

Please provide the name and address of your former church.

Would you like to be on our mailing list? *

Married: *

Anniversary:

Spouse's Name:

Spouse's Email Address:

I have attended Cursillo:

Date of Birth:

Place of Birth:

Phone:

Baptism Date:

Denomination of Baptism:

Place of Baptism:

Children living at home: *

Name of Child:

Date of Birth:

Baptism Date:

Confirmation Date:

Name of Child:

Date of Birth:

Baptism Date:

Confirmation Date:

Name of Child:

Date of Birth:

Baptism Date:

Confirmation Date: