Membership Web Form

General Information:

Last Name Only:       Address: (Street, Box, etc)

State:       Zip Code:

E-Mail:       Telephone: (Area Code First)

Adults in Household: (Everyone over 18 years)

1.) Full Name:

Title: Miss Ms. Mrs. Mr. Dr. Rev.

Sex: Female Male

Birth Date:

Birth Place:

Member Status

Communing? Yes No

Baptized? Yes No       Baptism Date:

Baptism Place:

Confirmed? Yes No       Confirmation Date:

Confirmation Place:

Employer:

Work Shift:       Occupation:

Education: Choose Highest Grade Completed
1 2 3 4 5 6 7 8 9 10 11 12
College 1 College 2 College 3 College 4

Graduate School: Yes No

Marital Status: Choose All That Apply Married Single Divorced Widow

Wedding Date: Divorce Date:

2.) Full Name:

Title: Miss Ms. Mrs. Mr. Dr. Rev.

Sex: Female Male

Birth Date:

Birth Place:

Member Status

Children (0-17 Years): Please list each one separately

1.) Child's Full Name:

Sex: Female Male

Birth Date:

Birth Place:

Member Status

Communing? Yes No

Baptized? Yes No Baptism Date:

Baptism Place:

Confirmed? Yes No Confirmation Date:

Confirmation Place:

Current Grade

Attend Sunday School? Yes No

2.) Child's Full Name:

Sex: Female Male

Birth Date:

Birth Place:

Member Status

Communing? Yes No

Baptized? Yes No Baptism Date:

Baptism Place:

Confirmed? Yes No Confirmation Date:

Confirmation Place:

Current Grade

Attend Sunday School? Yes No

3.) Child's Full Name:

Sex: Female Male

Birth Date:

Birth Place:

Member Status

Communing? Yes No

Baptized? Yes No Baptism Date:

Baptism Place:

Confirmed? Yes No Confirmation Date:

Confirmation Place:

Current Grade

Attend Sunday School? Yes No

4.) Child's Full Name:

Sex: Female Male

Birth Date:

Birth Place:

Member Status

Communing? Yes No

Baptized? Yes No Baptism Date:

Baptism Place:

Confirmed? Yes No Confirmation Date:

Confirmation Place:

Current Grade

Attend Sunday School? Yes No

Good Shepherd Lutheran Church ~ 876 Grove St. ~ Conneaut, Ohio 44030 ~ Phone: 440-599-8908
Good Shepherd Lutheran Church is completely handicapped accessible!
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