Parish Registration - Our Lady Mother of the Church

Family / Last *

Address 1 *

Address 2

City *

State

Zip

Phone Number *

Email

Member 1

First Name *

Last or Maiden Name *

Birth Date (Mo/D/Yr) *

If Married, Church of Marriage

Occupation / Student Current Grade

Religion *

Email if Applicable

Comments

Member 2

First Name *

Last or Maiden Name *

Birth Date (Mo/D/Yr) *

If Married, Church of Marriage

Occupation / Student Current Grade

Religion *

Email if Applicable

Comments

Member 3

First Name *

Last or Maiden Name *

Birth Date (Mo/D/Yr) *

If Married, Church of Marriage

Occupation / Student Current Grade

Religion *

Email if Applicable

Comments

Member 4

First Name *

Last or Maiden Name *

Birth Date (Mo/D/Yr) *

If Married, Church of Marriage

Occupation / Student Current Grade

Religion *

Email if Applicable

Comments

Member 5

First Name *

Last or Maiden Name *

Birth Date (Mo/D/Yr) *

If Married, Church of Marriage

Occupation / Student Current Grade

Religion *

Email if Applicable

Comments

Member 6

First Name *

Last or Maiden Name *

Birth Date (Mo/D/Yr) *

If Married, Church of Marriage

Occupation / Student Current Grade

Religion *

Email if Applicable

Comments

Member 7

First Name *

Last or Maiden Name *

Birth Date (Mo/D/Yr) *

If Married, Church of Marriage

Occupation / Student Current Grade

Religion *

Email if Applicable

Comments

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