Member information

Please fill out this form and click submit.

Last Name

*

First Proper Name (adult 1)

*

Nickname (adult 1)

Middle Name (adult 1)

Address (adult 1)

*

Email (adult 1)

*

This address will receive a confirmation email

Phone (adult 1)

*

Phone (adult 1 additional phone)

Birthdate (adult 1)

*

Baptism date (adult 1)

Confirmation date (adult 1)

First Proper Name (adult 2)

Nickname (adult 2)

Middle Name (adult 2)

Address (adult 2 - if different from above)

Email (adult 2)

This address will receive a confirmation email

Phone (adult 2)

Phone (adult 2 additional phone)

Birthdate (adult 2)

Baptism date (adult 2)

Confirmation date (adult 2)

Child 1's Proper Name

Child 1's Nickname

Child 1's Middle Name

Child 1's birthdate

Child 1's baptism date

Child 1's confirmation date

Child 1's graduating year

Child 2's Proper First name

Child 2's Nickname

Child 2's Middle Name

Child 2's birthdate

Child 2's baptism date

Child 2's confirmation date

Child 2's graduating year

Child 3's Proper First Name

Child 3's Nickname

Child 3's Middle Name

Child 3's birthdate

Child 3's baptism date

Child 3's confirmation date

Child 3's graduating year

Child 4's Proper First Name

Child 4's Nickname

Child 4's Middle Name

Child 4's birthdate

Child 4's baptism date

Child 4's confirmation date

Child 4's graduating year

Child 5's Proper First Name

Child 5's Nickname

Child 5's Middle Name

Child 5's birthdate

Child 5's baptism date

Child 5's confirmation date

Child 5's graduating year

My/Our preferred method of communication is

*

Please select one option.

email cell phone home phone

I/We would like to receive our monthly newsletter by

*

Please select one option.

email mailbox at church postal mail

I/We would like to receive a weekly email.

*

Please select one option.

yes no

I/We would like to give to my/our church by

*

Please select one option.

electronic giving (will sign up through Vanco) electronic giving through my bank envelopes

I/We are coming to Bethlehem

*

Please select one option.

from a non-Lutheran congregation another Lutheran congregation reinstatement to membership in Bethlehem baptism

If you are transferring from another congregation (Lutheran or non-Lutheran), please list the name of the congregation and their address. If you don't know the entire address, please list the city and state.

*

Description

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