Registration « The Basilica of Saint John the Evangelist

Registration

Parishioner Info

Your First Name(required)
Your Middle Name
Your Last Name(required)
Date of Birth(required)
Place of Birth(required)
Gender(required)
Religion(required)
Baptized?(required)
First Communion?(required)
Confirmation?(required)
Marital Status(required)
Occupation

Spouse and Marriage Info

Spouse's First Name
Spouse's Middle Name
Spouse's Last Name
Spouse's Date of Birth
Spouse's Place of Birth
Spouse's Religion
Baptized?
First Communion?
Confirmation?
Were you married in the Catholic Church?
Where were you married?
Wedding date:
Spouse's Occupation

Children (living at home)

Name
Date of Birth
Baptized?
First Communion?
Confirmation?
Name
Date of Birth
Baptized?
First Communion?
Confirmation?
Name
Date of Birth
Baptized?
First Communion?
Confirmation?
Name
Date of Birth
Baptized?
First Communion?
Confirmation?
List additional children here with information as above

Home Address

Street & Number(required)
Apt. No.
City(required)
State(required)
Zip Code(required)
Home Phone(required)
Home E-mail(valid email required)
Cell Phone

Business Address (if different from above)

Name of Company
Street & Number
Floor/Suite Number
City
State
Zip Code
Phone
Fax
E-mail

Spouse's Business Address (if different from above)

Name of Company
Street & Number
Floor/Suite Number
City
State
Zip Code
Phone
Fax
E-mail

Giving Information

Do you prefer electonic giving or weekly envelopes?(required)
If you prefer electronic giving you may fill out the following fields.
How much would you like to give?
How often would you like to give?
Name on the credit card
Credit card number
Expiration date
Is your home address the same as your billing address?
If you selected no please fill in your billing information below.
Street & Number
Floor/Suite Number
City
State
Zip Code

Volunteer Information

Would you volunteer in the parish?(required)
What is preferable work?

Final Questions

Parishioner at St. John's since
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Please enter this code before submitting:

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