St. Theresa Church

Membership Registration

(Stage I)

Basic Contact Information

Question Title

* 1. Can you share your name and your contact information?

first name

family name

email address

phone number

Question Title

* 2. Does your household have an additional representative?

yes the household has an additional representative

no the household has no additional representative

Question Title

* 3. If yes can you share his or her name and contact information?

first name

family name

email address

phone number

Question Title

* 4. What is the mailing address of your household?

address

city

postal code

Question Title

* 5. How many adults are you seeking to register?

1 to 2 adults

3 to 4 adults

Question Title

* 6. What is the first name and family name of each adult?

a - first name

a - family name

b - first name

b- family name

c - first name

c- family name

d - first name

d - family name

Question Title

* 7. How many children are you seeking to register?

no children

1 to 2 children

3 to 4 children

Question Title

* 8. What is the first name and family name of each child?

a - first name

a - family name

b - first name

b - family name

c - first name

c - family name

d - first name

d - family name

St. Theresa Church

Membership Registration (Stage I)

Question Title

* 1. Can you share your name and your contact information?

Question Title

* 2. Does your household have an additional representative?

Question Title

* 3. If yes can you share his or her name and contact information?

Question Title

* 4. What is the mailing address of your household?

Question Title

* 5. How many adults are you seeking to register?

Question Title

* 6. What is the first name and family name of each adult?

Question Title

* 7. How many children are you seeking to register?

Question Title

* 8. What is the first name and family name of each child?

Membership Registration

(Stage I)