Membership Request Form Your information is stored in our database. By completing this form you are giving Christ Church permission to publish your contact information (name, address, email, cell and home phone numbers) in our directory. Last Name (required) First Name (required) Middle Name (required) Maiden Name (If applicable) Street Address (required) City, State, Zip (required) Primary Phone Number (required) Is this your home or cell? (required) homecell Secondary Phone Is this secondary number your home or cell? homecell Email (required) Date of Birth (MM/DD/YYYY) (required) Marital Status (required) SingleMarriedDivorcedWidowedPartnered Have you been baptized? (required) yesno If you have been baptized, please tell us the date and place of baptism. Have you been confirmed? (required) yesno If you have been confirmed, please tell us the date and place of Confirmation. Were you a member of another Episcopal parish before coming to Christ Church? (required) yesno If yes, please provide name, city, and state of your previous church home.