St. Elizabeth Church

99-312 MOANALUA ROAD, AIEA, HI 96701

New/Update Membership Registration Form

Registration    New        Update

Family Name * (Sir Name, Last Name)

Address *

Address (Cont)

City *
State/Province *

Country
Zip/Postal Code *

Telephone Number *
Alternate Number

Email Address *
Fax Number

Head of Household:

First Name *
Last Name *

Date of Birth
Occupation

Employer
Work Phone

Spouse:

First Name *
Last Name *

Date of Birth
Occupation

Employer
Work Phone

Family Members

First Name
Last Name

Gender     M        F
Age

Date of Birth

Adult      Child

Relationship (Grandma, Grandpa, Aunty, Uncle, etc)

First Name
Last Name

Gender     M        F
Age

Date of Birth

Adult      Child

Relationship (Grandma, Grandpa, Aunty, Uncle, etc)

First Name
Last Name

Gender     M        F
Age

Date of Birth

Adult      Child

Relationship (Grandma, Grandpa, Aunty, Uncle, etc)

First Name
Last Name

Gender     M        F
Age

Date of Birth

Adult      Child

Relationship (Grandma, Grandpa, Aunty, Uncle, etc)

First Name
Last Name

Gender     M        F
Age

Date of Birth

Adult      Child

Relationship (Grandma, Grandpa, Aunty, Uncle, etc)

Do your children currently attend St. Elizabeth School?
Yes       No

Do your children currently attend CCD?   Yes        No

Do you need offertory envelopes? Yes        No

Are you involved in a ministry? If so, which one(s)?

Comments:

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