Shepherd of the Sea Lutheran Church New Member Information Form

Name:
Today's Date: --/--/----
Address:
Home Phone: xxx-xxx-xxxx
Cell Phone: xxx-xxx-xxxx
Emergency #xxx-xxx-xxxx
Work Phone: xxx-xxx-xxxx
Email Address:
Employer:
Birth Date: mm/dd/yyyy
Birth Place: mm/dd/yyyy
Baptized:	Yes No
Baptized Date: mm/dd/yyyy
Baptized Place:
Confirmed:	Yes No
Confirmed Date: mm/dd/yyyy
Confirmed Place:
Marital Status:	Married Widow (er) Divorced Single
Marriage Date: mm/dd/yyyy
Spouse's Name:
Birth Date: mm/dd/yyyy
Birth Place:
Baptized:	Yes No
Baptized Date: mm/dd/yyyy
Baptized Place:
Confirmed:	Yes No
Confirmed Date: mm/dd/yyyy
Confirmed Place:
SOS Membership Date: mm/dd/yyyy
How Did You Become a Member:	Transfer ELCA Transfer other Lutheran Transfer non-Lutheran Baptism (under 15) Baptism (Adult) Affirmation Other
Previous Congregation:
Previous Congregation Location:
First Child's Name:
Birth Date: mm/dd/yyyy
Grade:
Baptism Date: mm/dd/yyyy
Place:
Confirmed Date: mm/dd/yyyy
Place:
Second Child's Name:
Birth Date: mm/dd/yyyy
Grade:
Baptism Date: mm/dd/yyyy
Place:
Confirmed Date: mm/dd/yyyy
Place:
Alternative Address:
Dates: From mm/dd-mm/dd
Phone #: xxx-xxx-xxxx
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