Date* MM slash DD slash YYYY Family InformationFamily (Last) Name*Status* Permanent Resident Resident/Visitor Snowbird/Seasonal Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Address Different Than Mailing Address?* Yes No Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Cell Phone*Email* Head of Household EmailMy Home Phone Is* Listed Unlisted Children?* Yes No Mother's Maiden Name*Offering Envelopes:* Yes No Members of the HouseholdName* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Middle Last Date of Birth* Month Day Year M/F* Male Female Marital Status* Married Single Divorced Widowed Separated Occupation or School & Grade*Occupation (if retired, former occupation). School & Grade (for students)Work PhoneNumber of Additional Members*Please enter a number from 0 to 5.Religion (if not Catholic)*BaptismInclude Date, Church Name, City, & StateFirst EucharistChurch & DateConfirmationChurch & DateMarriage*Chruch & DateAdditional Member 1Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Middle Last Date of Birth* Month Day Year M/F* Male Female Marital Status* Married Single Divorced Widowed Separated Occupation or School & Grade*Occupation (if retired, former occupation). School & Grade (for students)Work PhoneCell PhoneReligion (if not Catholic)BaptismInclude Date, Church Name, City, & StateFirst EucharistChurch & DateConfirmationChurch & DateMarriage*Chruch & DateAdditional Member 2Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Middle Last Date of Birth* Month Day Year M/F* Male Female Marital Status* Married Single Divorced Widowed Separated Occupation or School & Grade*Occupation (if retired, former occupation). School & Grade (for students)PhoneReligion (if not Catholic)BaptismInclude Date, Church Name, City, & StateFirst EucharistChurch & DateConfirmationChurch & DateMarriage*Chruch & DateAdditional Member 3Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Middle Last Date of Birth* Month Day Year M/F* Male Female Marital Status* Married Single Divorced Widowed Separated Occupation or School & Grade*Occupation (if retired, former occupation). School & Grade (for students)PhoneReligion (if not Catholic)BaptismInclude Date, Church Name, City, & StateFirst EucharistChurch & DateConfirmationChurch & DateMarriage*Chruch & DateAdditional Member 4Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Middle Last Date of Birth* Month Day Year M/F* Male Female Marital Status* Married Single Divorced Widowed Separated Occupation or School & Grade*Occupation (if retired, former occupation). School & Grade (for students)PhoneReligion (if not Catholic)BaptismInclude Date, Church Name, City, & StateFirst EucharistChurch & DateConfirmationChurch & DateMarriage*Chruch & DateAdditional Member 5Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Middle Last Date of Birth* Month Day Year M/F* Male Female Marital Status* Married Single Divorced Widowed Separated Occupation or School & Grade*Occupation (if retired, former occupation). School & Grade (for students)PhoneReligion (if not Catholic)BaptismInclude Date, Church Name, City, & StateFirst EucharistChurch & DateConfirmationChurch & DateMarriage*Chruch & DateCAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
