Membership Information Form | St Simons Episcopal Church

Today's Date(Required)

Mailing Address (Street, City, State, Zip)(Required)

Do you want family members donation information kept separate or combined?(Required)

Combined

Separate

1. Family Member 1

Info for the first member of the family

1. Family Member 1

Info for the first member of the family

1. Full name (first, middle, maiden, last)(Required)

1. Email

The email address to receive emails from the church

1. Primary Phone Number(Required)

1. Type of phone line(Required)

Mobile

Land line

1. Gender

1. Date of birth(Required)

1. Place of birth(Required)

City and State

Is this person baptized?(Required)

Yes

1. Place of baptism (if known)

City, State, Church name

1. Register this baptism at St Simon's?

We can add your baptism to our Parish registry if you like.

Yes

1. Date of Confirmation

If confirmed in another church. Skip if not confirmed.

1. Church and Location of your confirmation

What church and in what city/state were you confirmed in? Skip if not confirmed.

1. Would you like your membership moved from a previous church to St. Simon's?

We can request a letter of transfer if you would like

Yes

1. Do you have another family member to add?(Required)

Click Yes if you have additional members, you will be prompted again after each form.

Yes

Family Member 2

Info for 2nd family member

2. Relationship to member 1?

Is this a spouse, partner, parent, or child of member 1?

Spouse / Partner

Child

Parent

2. Gender

2. Is this person baptized?

Check ONE

Yes

Unsure

3. Family Member 3

if applicable

3. Relationship to Member 1?

How is this person related to the primary member?

Spouse / Partner

Child

Parent

3. Email

email address for the 3rd family member if any

3. Primary phone number

This member's primary number, can be a parent if preferred

3. Gender

3. Place of birth

City and State

3. Is this person baptized?

Choose ONE

Yes

Unsure

3. Date and place of baptism

Include church and location

3. Date and place of Confirmation

If confirmed in another church, please enter date, location and church name. If not confirmed just say "Not confirmed"

4. Family Member 4

if applicable

4. Relationship to member 1?

How is this person related to the primary member?

Spouse / Partner

Child

Parent

4. Primary phone number

Can use parent's number

4. Gender

4. Date and place of baptism

Include church name and location. If not baptized please respond "Not Baptized"

4. Date and place of confirmation

Location and church name. If not confirmed respond "Not Confirmed"

4. Additional family members?

Click YES if you have any additional family members to add

Yes

Nope