Member Information Form

Name*: Age: Birthday:

Home: Cell: Work:

Your Email*:

Address*:

Winter Address:

Your Place of Employment:

Spouse Information:

Spouse Name: Age: Birthday:

Spouse Cell: Spouse Work:

Spouse Email:

Spouse Place of Employment:

Baptized  yes  No  I don't know

If yes-approximate date: Place:

I will join by

 Profession of Faith

 Reaffirmation of Faith

 Letter of Transfer fromname of prior church

Please fill out the following if you have previously been a part of a PCUSA Congregation.

 Elder: Date of Ordination: Dates of Service:

Church: City/State:

 Deacon: Date of Ordination: Dates of Service:

Church: City/State:

Children's names

1. Bday: Age: School Grade:

2. Bday: Age: School Grade:

3. Bday: Age: School Grade:

4. Bday: Age: School Grade:

5. Bday: Age: School Grade:

In Case of Emergency

Emergency Name to Contact:

Contact's Address:

Phone(s) to Contact:

Next of Kin

Name:

Address:

Phone(s) to Contact:

Please write a short paragraph that will be used to introduce you and your family to the Congregation.

Thank you for completing this form. Welcome to Echo Hill Presbyterian Church.

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