Church Registration Form

Family Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Phone Number # 2 Please enter a phone number.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Would you like information on electronic transfer of contributions: REQUIRED Yes No Please fill out this field.

Marital Status REQUIRED Please fill out this field.

Were you married by a:

Church of marriage and date Please enter valid data.

St. Philip Roman

Catholic Church