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Member Registration

Personal Information
Title:
First Name:
Middle Name:
Last Name:
Suffix:
Gender:
Family: (If a family member, select the appropriate family from the list. Otherwise, leave this as is)
Family Role: (Select the your appropriate role, if a family else, select Unassigned.)
Your Address
Address1:
Address2:
City:
State: OR
(Use the textbox for countries other than US and Canada)
Zip:
Country:
Membership Date:   [format: YYYY-MM-DD]
(when you joined the church)
Classification:
Other Information
Home Phone: (Format: xxx-xxx-xxxx)
Do not auto-format
Work Phone: (Format: xxx-xxx-xxxx Ext. xxx.)
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Mobile Phone: (Format: xxx-xxx-xxxx)
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Email:
Work / Other Email:
Birth Date: (4-digit year)
Verification Code:
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