Full Name (required): Your Email (required):
Address City , State Zip
Phones: Home Cell Work
Birth date: Marital Status SingleMarriedDivorcedWidowed Wedding Anniversary
Baptized? YesNoWish to be Date: Where?
Confirmed? YesNoWish to be Date: Where?
How did you find out about Epiphany?
Members of Epiphany are expected to regularly attend worship services, give financially to support the ministry of the church, and be involved in ministry at Epiphany. Would you like to become a member? YesNo Previous Church Attended?
Can we publish your name, address, phone number and email in our Parish Directory? YesNo
Spouse (if applicable)
Full Name: Email:
Phones: Cell Work
Children Under Age of 18
Full Name: Birth date: Current Grade:
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