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Welcome to St. Joseph – St. Lawrence Catholic Parish
Parish Registration Form
P. O. Box 129, Easton, KS 66020
(913) 772-5712
PLEASE PRINT
TODAY’S DATE _______/_______/_______
LAST NAME: ____________________________________________________ WIFE’S MAIDEN NAME: ______________________________________
FIRST: __________________________________________________MI _____ SPOUSE: ___________________________________________ MI_____
MAILING ADDRESS: (CHECK ONE) MR./ MRS. MR. MRS MS. MISS DR./MRS. RANK ___________ OTHER __________________
ADDRESS: ________________________________________________________________________________________________________________________
CITY/STATE: ______________________________________________________________________________________ ZIP CODE:______________________
PRIMARY HOME PHONE #: _______________________________________________________ UNLISTED __________ (Y) _______ (N)
HIS CELL PHONE #: _____________________________________________________ HER CELL PHONE: __________________________________________
HIS WORK PHONE #: ____________________________________________________ HER WORK PHONE: _________________________________________
HIS E-MAIL: _______________________________________________________ HER E-MAIL: _____________________________________________________
FAMILY E-MAIL ADDRESS :___________________________________________________________________________________________________________
Are you a temporary military resident? (Y/N) __________ Date of Departure: ______________________
COMMENTS: ________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Please complete information on back of form.
OFFICE USE ONLY
ENVELOPE # : ____________
IN DATABASE: ___________
DATE: ___________________
INITIALS: ________________