Member Form - Perry Highway Lutheran Church

New Member Form

New Member

Head of Household

Enter First, Middle and Last Name

Maiden Name (if applicable)

(First Middle Last & Maiden)

Address

City

State

Zip

Phone Home

Cell

Work

Occupation

Employed By

Date of Birth

Place of Birth

Radio Buttons

Date of Baptism

Pastor

Place of Baptism

God Parents

Father's Full Name

First, Middle, Last

Mother's Full Name

First, Middle, Last

If you are human, leave this field blank.

A new member form should be filled out for each household member.