Skip to content
Home
Church
Services
Resources
Online Offering
Our Pastor
Child Care
Preschool
Daycare
Our Staff
Registration Forms
Events
Vacation Bible School
History
Contact
Home
Church
Services
Resources
Online Offering
Our Pastor
Child Care
Preschool
Daycare
Our Staff
Registration Forms
Events
Vacation Bible School
History
Contact
Member Information
Tell Us About Yourself
Member Information Form
Fields marked with an
*
are required
Head of Household
Submission
First Name
*
Maiden Name
Last Name
*
Name prefer to be called
Date of Birth
*
Gender
*
Male
Female
U.S. Citizen?
*
Yes
No
Address
*
Home Phone
Cell Phone
*
City
*
State
*
- Select State -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST
ARMED FORCES AMERICA (EXCEPT CANADA)
ARMED FORCES PACIFIC
Zip
*
Baptism Date
Congregation baptized in/location
Confirmed Lutheran?
Yes
No
Confirmation Date
Congregation confirmed in/location
Marital status
*
Single
Married
Widowed
Divorced
Name of spouse
Wedding Date
Occupation
*
Employer
Number
Email
*
Do you have a spouse that is a member of the church?
*
Yes
No
How many children do you have in your household that are church members?
*
If you are a human seeing this field, please leave it empty.
January
February
March
April
May
June
July
August
September
October
November
December
Sun
Mon
Tue
Wed
Thu
Fri
Sat
27
28
29
30
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
1
2
3
4
5
6
7
January
February
March
April
May
June
July
August
September
October
November
December
Sun
Mon
Tue
Wed
Thu
Fri
Sat
27
28
29
30
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
1
2
3
4
5
6
7
January
February
March
April
May
June
July
August
September
October
November
December
Sun
Mon
Tue
Wed
Thu
Fri
Sat
27
28
29
30
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
1
2
3
4
5
6
7
January
February
March
April
May
June
July
August
September
October
November
December
Sun
Mon
Tue
Wed
Thu
Fri
Sat
27
28
29
30
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
1
2
3
4
5
6
7