Name

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthday *

We will not share birth-years for adults in the directory, but we would like to have birth-years in our records, if you're willing to share that with our staff. If you'd rather not, you may just put this year.

MM

DD

YYYY

Baptismal Birthday

If you know it : )

MM

DD

YYYY

Mobile Phone

(###)

###

####

Home Phone

(###)

###

####

Which phone number is best to reach you? We'll list that one first.

Mobile

Home

Text-Messaging Preferences *

This is for other congregants to know whether or not you're okay receiving text messages from them.

I prefer no text messaging

I'm happy to receive text messages

I don't have text messaging