Member Information Change Form

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  Member Information Change Form
  
  If you have recently moved, changed your phone number, changed your name, or would like to add or change a cell number, work number, or email address, please fill out this form and submit to the Parish Office.
  
  Date REQUIRED Please fill out this field. Please enter a date.
  
  HEAD OF HOUSEHOLD CURRENTLY ON FILE
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  CHANGE OR ADD THE FOLLOWING INFORMATION
  
  Home Phone (Identify if changing or deleting) Please enter a phone number.
  
  Work Phone (Identify Who) - Change or Delete? Please enter a phone number.
  
  Cell Phone (Identify Who) - Change or Delete? Please enter a phone number.
  
  Email Please enter an email address.
  
  Emergency Contact Information Please enter valid data.
  
  Change Primary Home Address to: Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Change Name (i.e. Marriage) Please enter valid data.
  
  Other Information
  
  Submit
- Mass Times
  
  Saturday: 4:30 PM EnglishEnglishEN Kimberly
  
  Sunday: 7:30 AM EnglishEnglishEN Darboy 9:30 AM EnglishEnglishEN Kimberly 5:30 PM EnglishEnglishEN Kimberly
- Confession Times
  
  Saturday: 3:30 PM Kimberly

Member Information Change Form

Member Information Change Form

CHANGE OR ADD THE FOLLOWING INFORMATION