Membership Info Online Please fill out a separate form for all family members. All information is confidential and will never be shared with an outside entity. Your-Name (First, Middle and Last) Maiden Name (optional) Address Street Address Address Line 2 City State Postal / Zip Code Country Telephone - Home Publish ---YesNo Telephone - Cell (optional) Publish (optional) ---YesNo Email (optional) Publish (optional) ---YesNo Birthday (MM/DD/YYYY) Publish ---YesNo Anniversary (optional) Baptism Baptism Date MM/DD/YYYY (if Yes) ---YesYes - but date is unknownNo Confirmation Confirmation Date MM/DD/YYYY (if Yes) ---YesYes - but date is unknownNo Received/Transferred Received/Transferred Date MM/DD/YYYY (if Yes) ---YesYes - but date is unknownNo Prior Church Membership (optional) Groups Involved With (optional) Interests/Hobbies (optional) Professional Fields/Services (optional) Spouse Parent(s) (if a child) Child(ren) Yes! I would like to be included in the online directory! Yes! I would like to transfer my membership to St. Mark’s! Yes! I would like offering envelopes!