Test page 3 - Easley Presbyterian Church

Name- Adult 1

First

Last

Middle

Name you wish to be called - Adult 1

Phone - Adult 1

Area Code

Phone Number

Email - Adult 1

Birth Date - Adult 1

Baptism Date - Adult 1

Occupation/Place of Employment - Adult 1

Work Phone - Adult 1

Area Code

Phone Number

Past ordained Elder or Deacon - Adult 1

Elder

Deacon

Name - Adult 2

First

Last

Middle

Name you wish to be called 2

Phone - Adult 2

Area Code

Phone Number

Email - Adult 2

Birth Date - Adult 2

Baptism Date - Adult 2

Occupation/Place of Employment - Adult 2

Work Phone - Adult 2

Area Code

Phone Number

Past ordained Elder or Deacon - Adult 2

Elder

Deacon

Do you wish to have offering envelopes?

Yes

Would you like to receive the newsletter by email?

Yes

Additional Name 1

First

Last

Middle

Name you with to be called 1

Gender 1

Male

Female

Birth Date 1

Grade in School 1

Baptism Date 1

Confirmation Date 1