Personal Information

First Name
Middle Name if applicable
Patronymic if applicable
Last Name
Birthday
Patron Saint if known
Nameday if known
If you were previously a member of another parish, please provide the parish name, location, and jurisdiction

Address information

Street Address
City
State
ZIP Code (Required)

Communications Information

Mobile Phone
Landline Phone
Work Phone
Main email
Secondary email

Employment Information

Occupation

In what area can you possibly provide practical help to our parish?

Recommendation of two parishioners in good standing

Full Name of the 1st Recommender
Mobile Phone
Email

Full Name of the 2nd Recommender
Mobile Phone
Email

I pledge to make the following suggested parish membership contributions:

working parish member ($37 per month minimum)non-working parish member or student ($18 per month minimum)retired parish member ($18 per month minimum)I am experiencing financial hardship and am unable to pay any suggested parish membership contribution. Nevertheless, please accept me as an official member of the parish.

Parish Dues are adjusted annually according to the federal COLA (Cost Of Living Adjustment).

Applicant's signature (typing your full name here counts as a signature):

Date of this application:

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