Membership Request Form Part 2 -

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)

Secondary Phone

Is this secondary number your home or cell?

Email (required)

Date of Birth (MM/DD/YYYY) (required)

Marital Status (required)

Have you been baptized? (required)

If you have been baptized, please tell us the date and place of baptism.

Have you been confirmed? (required)

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)

If yes, please provide name, city, and state of your previous church home.