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St. Theresa Church
Membership Registration
(Stage I)
Basic Contact Information
1.
Can you share your name and your contact information?
first name
family name
email address
phone number
2.
Does your household have an additional representative?
yes the household has an additional representative
no the household has no additional representative
3.
If yes can you share his or her name and contact information?
first name
family name
email address
phone number
4.
What is the mailing address of your household?
address
city
postal code
5.
How many adults are you seeking to register?
1 to 2 adults
3 to 4 adults
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
7.
How many children are you seeking to register?
no children
1 to 2 children
3 to 4 children
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