Church Contact Information/Directory Form

Please include me/us in the Church Directory?  Yes, please. No, this is for your information only.

INSTRUCTIONS:
Enter all information that is applicable. If you do want to be in the church directory but do not wish particular information to be published in the directory, click "no" next to "Include in directory?" for that information. If you have any additional comments you would like to make about your contact details, you can do so in the "Additional information" field at the bottom of the page.
When you have finished, click the "Send" button at the bottom of the page. The information will then be sent to us via email.

Your First Name:

Last Name:

Your Mobile:
Include in directory?  yes no
Your Email:
Include in directory?  yes no
Your Birthday:
---JanuaryFebruaryMarchAprilMay JuneJulyAugustSeptemberOctoberNovemberDecember ---12345678910111213141516171819202122232425262728293031 Year (optional): Include in directory?  yes no

Home phone: Include in directory?  yes no

Street address:
     City: State: Zip: Include in directory?  yes no

Is mailing address the same as home address?  yes no If "no", Mailing Address:
                   City: State: Zip: Include in directory?  yes no

Upload individual/family photo to include in the church directory (.jpg file):
File location:
(Click "Browse" to find the photo on your computer and select it.
The photo will upload when you press "Send" after you complete the form)
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Spouse First Name:

Spouse Last Name:

Spouse Mobile:
Include in directory?  yes no
Spouse Email:
Include in directory?  yes no
Spouse Birthday:
---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---12345678910111213141516171819202122232425262728293031 Year (optional): Include in directory?  yes no

Wedding Anniversary:
---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---12345678910111213141516171819202122232425262728293031 Year: Include in directory?  yes no

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Child Name:

Mobile:
Include in directory?  yes no
Email:
Include in directory?  yes no
Birthday:
---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---12345678910111213141516171819202122232425262728293031 Year: Include in directory?  yes no

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Child Name:

Mobile:
Include in directory?  yes no
Email:
Include in directory?  yes no
Birthday:
---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---12345678910111213141516171819202122232425262728293031 Year: Include in directory?  yes no

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Child Name:

Mobile:
Include in directory?  yes no
Email:
Include in directory?  yes no
Birthday:
---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---12345678910111213141516171819202122232425262728293031 Year: Include in directory?  yes no

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Child Name:

Mobile:
Include in directory?  yes no
Email:
Include in directory?  yes no
Birthday:
---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---12345678910111213141516171819202122232425262728293031 Year: Include in directory?  yes no

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Child Name:

Mobile:
Include in directory?  yes no
Email:
Include in directory?  yes no
Birthday:
---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---12345678910111213141516171819202122232425262728293031 Year: Include in directory?  yes no

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Child Name:

Mobile:
Include in directory?  yes no
Email:
Include in directory?  yes no
Birthday:
---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---12345678910111213141516171819202122232425262728293031 Year: Include in directory?  yes no

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Additional comments:

Please enter the text from this image into the box below.