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2018 Stewardship Offertory Commitment
Compromiso de Ofrendas para 2018
2018 Annual Diocesan Appeal
Columbarium
Event Request Form
Faith Direct
Parish Registration Form
Photo Albums
Stained Glass Windows
The maximum number of form submissions has been reached. This form is currently not available.
Immaculate Conception Catholic Church Parish Regisgration Form
In order that we may serve you better, please complete this form as fully as possible.
Do you wish to receive contribution envelopes? (Annual boxed set)
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Do you wish to receive information about contributing electronically? (Faith Direct)
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Street Address
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Please include Apt#, Lot#, Trlr#, etc.
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Zip
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Mailing Address (If different from street address)
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City
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DC
DE
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HI
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MA
MD
ME
MH
MI
MN
MO
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MT
NC
ND
NE
NH
NJ
NM
NV
NY
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OK
OR
PA
PR
PW
RI
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VT
WA
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Zip
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Family/Primary Telephone
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Please enter a phone number.
Phone Type
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(Select One)
Home (Land line)
Cell
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Unlisted?
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If yes is selected, we will not list your number in the parish directory.
(Select One)
No
Yes
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Email
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Please enter an email address.
Would you prefer to receive correspondence via email including personal financial statements?
Yes
No
Single Person or Head of Household
Select Preferred Salutation
None
Mr.
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Ms.
Miss
Other
First Name
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Last Name
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Maiden or Middle Name (if applicable)
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Please Select (if applicable)
Maiden Name
Middle Name
Date of Birth
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MM/DD/YYYY
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Please enter a date.
Occupation
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Phone Number
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Please enter a phone number.
Preferred Language
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If other, please specify.
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Religion
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If other, please specify.
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Sacraments Received
Please select all that apply.
Baptism
First Communion
Reconciliation
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Ethnicity (optional for Diocesan Statistics)
Caucasian (White, Anglo)
Hispanic
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Other
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Current Marriage Status
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Married
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Priest or Religious
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Married in:
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Catholic Church
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If married, please include the date.
MM/DD/YYYY
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Marriage Dissolution
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N/A
Please provide date of dissolution if applicable.
MM/DD/YYYY
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Spouse (if applicable)
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None
Mr.
Mrs.
Ms.
Miss
Other
First Name
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Last Name
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Maiden or Middle Name (if applicable)
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Please Select (if applicable)
Maiden Name
Middle Name
Date of Birth
MM/DD/YYYY
Please enter a date.
Occupation
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Phone Number
Please enter a phone number.
Preferred Language
English
Spanish
Other
If other, please specify.
Please enter valid data.
Religion
Catholic
Jewish
Protestant
Other
If other, please specify.
Please enter valid data.
Sacraments Received
Please select all that apply.
Baptism
First Communion
Reconciliation
Confirmation
Ethnicity (optional for Diocesan Statistics)
Caucasian (White, Anglo)
Hispanic
African American
Other
If other, please specify.
Please enter valid data.
Children (under 18) living in your household. Please include first & last name, gender, date of birth, school grade and all sacraments received.
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