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St. Mildred Catholic Church Registraton Form.
1. Marital Status, Sex and E-Mail Address
Last Name
*
Your E-Mail adress.
*
🛈
Are you:
*
Married
Separated
Divorced
Widowed
Single
Sex
*
Male
Female
2. Please fill in your complete address
Address
*
City
*
State
*
Zip
*
3. Mailing address if different from above.
Address
City
State
Zip
4. Telephone to include area code.
Primary Telephone Number
5. Envelopes
Do you want envelopes?
*
Yes
No
Church
Yes
No
6. Information for each person that you are registering. If you are registering as a SINGLE , DIVORCED or WIDOWED person please use the OTHER line for you information.
Please fill out Full Name, Date of Birth, Religion of Husband/Wife . Please put a x in unused blocks.
*
Name (Last, First)
Date of Birth MM/DD/YY
Religion
Husband
Name (Last, First)
Date of Birth MM/DD/YY
Religion
Wife
Name (Last, First)
Date of Birth MM/DD/YY
Religion
Please fill out Full Name, Date of Birth, Religion of Children that are living with you. Children over 21 should register on their own.
Name (Last, First)
Date of Birth MM/DD/YY
Religion
Child 1
Name (Last, First)
Date of Birth MM/DD/YY
Religion
Child 2
Name (Last, First)
Date of Birth MM/DD/YY
Religion
Child 3
Name (Last, First)
Date of Birth MM/DD/YY
Religion
Child 4
Name (Last, First)
Date of Birth MM/DD/YY
Religion
Please fill out Full Name, Date of Birth, Religion if you are Single, Divorced or Windowed.
Name (Last, First)
Date of Birth MM/DD/YY
Religion
Other
Name (Last, First)
Date of Birth MM/DD/YY
Religion
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