EmailMe Form - Membership Information Form

Name

First Last

* Name you like to be called

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home Phone

### - ### - ####

Cell Phone

### - ### - ####

Email

What is your preferred method of communication?

home phone

cell phone

email

text messaging

Do you want to be on our emailing list for the church news?

yes

no

If yes, preferred emailing address:

Full date of birth

Please use spaces to separate month, day & year.

Baptized?

yes

no

If yes, please list date:

Job Title

Business Phone

### - ### - ####

Extension

Work Email

Marital Status:

Married

Single

Divorced

Widowed

Name of church from which you are transferring:

City/State:

Have you been ordained as an Elder in the PC(USA)?

yes

no

Children Information (List Children under 18):

Name / Full Date of Birth / Grade Level:

Additional Information about You:

1. Where did you grow up?

2. Where did you go to school?

3. What is your occupation?

4. What do you do in your spare time?

5. What else can you tell us about yourself and your family?

* Do you grant permission for the following information to be sent to all members by email, future publications in the church's in-house pictorial membership directory?

Please check below:

your photograph:

yes

no

your email address / home address / home ph. number & cell ph. number:

yes

no

How did you hear about St. Philip?

drove by

website

invited by a friend

other:

What helped you to decide to join St. Philip?

other:

Please indicate which church activities/service opportunities interest you?

other:

EMERGENCY CONTACT INFORMATION:

name of contact:

relationship:

### - ### - ####

contact's phone number (1):

### - ### - ####

contact's phone number (2):

Do you need any of the following accommodations for:

hearing

sight

mobility

Additional notes:

Racial / Ethnic / Group Identification ~ information is voluntary
[ used for demographic purposes only ]

Other:

Thank you for completing the online form and becoming a member!

Please contact us with any questions you may have:
phone: (713) 622-4807
e-mail: welcome@saintphilip.net

{ click the SUBMIT BUTTON to finalize the completed form }