(Confidential, for church use only)

Please block copy into Word or other word processing program, fill in and return to the church office by email to

stanthonystgeorge@yahoo.com.

FAMILY  LAST  NAME                                                                 PHONE  NUMBER

ADDRESS

FIRST   NAME                                  MIDDLE  NAME            

 MARITAL  STATUS    _____SINGLE

                                         _____MARRIED – DATE OF  MARRIAGE__________________

                                         _____WIDOW(ER) – DATE  OF DECEASED_________________

                                          _____DIVORCED - DATE OF DIVORCE ___________________

RELIGION:    

(   )  MARONITE   (   ) LATIN   (   ) BYZANTINE  (   ) OTHER   _______________________

OCCUPATION____________________________BUSINESS__________________________

DO YOU TAKE PART IN ANY OF THESE  PARISH ORGANIZATIONS:

(   ) ADVISORY BOARD  (   ) LECTOR  (   ) MRE  TEACHER  (   ) CHOIR

FIRST  NAME                                             MIDDLE  NAME

MARITAL STATUS   _____SINGLE

                                      _____MARRIED – DATE OF MARRIAGE____________________

                                      _____WIDOW(ER) – DATE OF DECEASED__________________

                                       _____DIVORCED – DATE OF DIVORCE____________________

RELIGION:

(  ) MARONITE  (   ) LATIN  (   ) BYZANTINE  (   ) OTHER  ______________________

OCCUPATION____________________________BUSINESS_________________________

DO YOU TAKE PART IN ANY OF THESE PARISH ORGANIZATIONS:

(  ) ADVISORY BOARD  (  ) ALTAR & ROSARY  (  )  LECTOR  (  ) MRE  TEACHER

DEPENDENT  CHILDREN

FIRST  AND  LAST  NAME                                                           DATE  OF  BIRTH

(  ) MALE                     (  ) BAPTIZED                               PARISH ORGANIZATIONS:

(  ) FEMALE                (  ) CONFIRMED                           (  ) MRE  CLASSES

                                     (  ) FIRST COMMUNION              (  ) MYO  OR  (  )  MYA

                                                                                              (  ) CHOIR       (  ) SERVER

FIRST  AND  LAST  NAME                                                           DATE  OF  BIRTH

(  ) MALE                     (  ) BAPTIZED                               PARISH ORGANIZATIONS:

(  ) FEMALE                (  ) CONFIRMED                           (  ) MRE  CLASSES

                                     (  ) FIRST COMMUNION              (  ) MYO  OR  (  )  MYA

                                                                                              (  ) CHOIR       (  ) SERVER

FIRST  AND  LAST  NAME                                                           DATE  OF  BIRTH

(  ) MALE                     (  ) BAPTIZED                               PARISH ORGANIZATIONS:

(  ) FEMALE                (  ) CONFIRMED                           (  ) MRE  CLASSES

                                     (  ) FIRST COMMUNION              (  ) MYO  OR  (  )  MYA

                                                                                              (  ) CHOIR       (  ) SERVER

FIRST  AND  LAST  NAME                                                           DATE  OF  BIRTH

(  ) MALE                     (  ) BAPTIZED                               PARISH ORGANIZATIONS:

(  ) FEMALE                (  ) CONFIRMED                           (  ) MRE  CLASSES

                                     (  ) FIRST COMMUNION              (  ) MYO  OR  (  )  MYA

                                                                                              (  ) CHOIR       (  ) SERVER

revised 9/1/06