Future Member Form

Person Completing Form *

Please select one

Mr.

Mrs.

Miss.

Ms.

Dr.

Rev.

Other

Name *

First Name

Last Name

Gender

Male

Female

Prefer not to answer

Birthdate *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Type

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Mobile

Phone

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###

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Marital Status

Married

Single

Widow/Widower

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I am interested in... *

Please Check all that Apply

4 Week Newcomer Series

Learning about Baptism

Transferring my Membership from Another Episcopal Church

Talking with a Priest

Spouse

Please select one

Mr.

Mrs.

Miss.

Ms.

Dr.

Rev.

Other

Name

First Name

Last Name

Gender

Male

Female

Prefer not to answer

Spouse Birthday

MM

DD

YYYY

Spouse Phone Type

Home

Mobile

Phone

(###)

###

####

Spouse Address if Different

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Anniversary Date

MM

DD

YYYY

Would you like to be a Member of St. Francis in-the-Field?

Yes

No

Would you like us to request your transfer to St. Francis in-the-Field?

Yes

No