Peace Evangelical Lutheran Church of South Haven

New Member Information Form

Full Name (Required)

(First Middle Last)

Preferred Name

Address (Required)

Home Phone

Cell Phone

E-mail Address

Birthdate

Birth Place

Parents Name

If new member is a child, please specify the name of their parents or guardians.

Baptized

Date of Baptism

Confirmed?

Confirmation Date

Place of Confirmation

Relationship Status

Name of Spouse/Partner

Wedding Date

Wedding Place

(City and State)

Communication

Do you wish to receive communications such as mailings, newsletters, weekly events, etc.?

Preferred Contact Method

How is it best to contact you?

Permission

May we have your permission to list your birthdate and/or wedding anniversary (without the year) in our calendar and publications?

Peace Evangelical Lutheran Church of South Haven

06321 Blue Star Memorial Highway, South Haven, MI 49090