Online Member Information Form

Name of Head of Household*

First Middle Last

Date of Birth*

mm/dd/yyyy

Birth Place

City and State

Baptism Date

Baptism Location

Church, City, and State

Confirmation Date

Confirmation Location

Church, City, and State

Ethnic Origin

Native American, White, Black, Hispanic, etc.

Prior Surname

If applicable.

Cell Phone Number*

Primary Email Address*

Household Mailing Address*

Street Address City State ZIP Code

Do you have another Household Phone Number?

Landline or House phone, if applicable.

Any other Household Email Address?

Family or shared email address, if applicable.

Present/Former Church Membership

Please include address and denomination.

Shall we request from the church listed above to transfer your membership to Zion?

Yes
No

Occupation Title

Employer

If it is acceptable for you to receive calls at work, please list work phone number and extension:

Education Level

Grade level or Degree completed

Marital Status*

Married
Partner living in same household
Single
Divorced
Widowed

Wedding Date*

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Spouse or Partner

Name of Spouse or Partner*

First Middle Last

Date of Birth*

mm/dd/yyyy

Birth Place

City and State

Baptism Date

Baptism Location

Church, City, and State

Confirmation Date

Confirmation Location

Church, City, and State

Ethnic Origin

Native American, White, Black, Hispanic, etc.

Prior Surname

If applicable.

Cell Phone Number*

Primary Email Address*

Occupation Title

Employer

If it is acceptable for you to receive calls at work, please list work phone number and extension:

Education Level

Grade level or Degree completed

Number of children:*

Please enter a number from 0 to 5.

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Children Information

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Child 1

CHILD'S FULL NAME*

First Middle Last

Gender

Male
Female

Date of Birth*

mm/dd/yyyy

Birth Place

City and State

Current Grade

Click on the drop-down arrow to select grade from the list of options.

Baptism Date

Baptism Location

Church, City, and State

Confirmation Date

Confirmation Location

Church, City, and State

Ethnic Origin

Native American, White, Black, Hispanic, etc.

Cell Phone Number

Email Address

This field is hidden when viewing the form

Child 2

CHILD'S FULL NAME*

First Middle Last

Gender

Male
Female

Date of Birth*

mm/dd/yyyy

Birth Place

City and State

Current Grade

Click on the drop-down arrow to select grade from the list of options.

Baptism Date

Baptism Location

Church, City, and State

Confirmation Date

Confirmation Location

Church, City, and State

Ethnic Origin

Native American, White, Black, Hispanic, etc.

Cell Phone Number

Email Address

This field is hidden when viewing the form

Child 3

CHILD'S FULL NAME*

First Middle Last

Gender

Male
Female

Date of Birth*

mm/dd/yyyy

Birth Place

City and State

Current Grade

Click on the drop-down arrow to select grade from the list of options.

Baptism Date

Baptism Location

Church, City, and State

Confirmation Date

Confirmation Location

Church, City, and State

Ethnic Origin

Native American, White, Black, Hispanic, etc.

Cell Phone Number

Email Address

This field is hidden when viewing the form

Child 4

CHILD'S FULL NAME*

First Middle Last

Gender

Male
Female

Date of Birth*

mm/dd/yyyy

Birth Place

City and State

Current Grade

Click on the drop-down arrow to select grade from the list of options.

Baptism Date

Baptism Location

Church, City, and State

Confirmation Date

Confirmation Location

Church, City, and State

Ethnic Origin

Native American, White, Black, Hispanic, etc.

Cell Phone Number

Email Address

This field is hidden when viewing the form

Child 5

CHILD'S FULL NAME*

First Middle Last

Gender

Male
Female

Date of Birth*

mm/dd/yyyy

Birth Place

City and State

Current Grade

Click on the drop-down arrow to select grade from the list of options.

Baptism Date

Baptism Location

Church, City, and State

Confirmation Date

Confirmation Location

Church, City, and State

Ethnic Origin

Native American, White, Black, Hispanic, etc.

Cell Phone Number

Email Address

This field is hidden when viewing the form

Section Break

Additional Information:

List additional information here:

New Member Information Form

Spouse or Partner

Children Information

Child 1

Child 2

Child 3

Child 4

Child 5

Section Break

E-GIVING