Mary Mother of God - New Parishioner Information

We are an Area Faith Community consisting of 4 Parishes. Please select only 1 Parish to register under.

Page 1 of 8 - New Parishioner Information

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St. Mary - Cottonwood

St. Mary - Cottonwood St. Mary Cottonwood only
Holy Redeemer - Marshall

Holy Redeemer - Marshall Holy Redeemer Marshall only
St. Michael - Milroy

St. Michael - Milroy St. Michael Milroy only
St. Mary - Tracy

St. Mary - Tracy St. Mary Tracy only
Name (First, Middle, and Last) Name (First, Middle, and Last) First Middle Last
Maiden Name (if applicable) Maiden Name (if applicable) First Last
Gender:
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Primary Phone Primary Phone - ### - ### ####
Is your primary phone a cell phone or a landline?
Secondary Phone Secondary Phone - ### - ### ####
Is your secondary phone a cell phone or landline?
Email
Do you wish to receive Parish emails?
My Date of Birth My Date of Birth / MM / DD YYYY
My Place of Employment and the Phone Number
My Religion
Are you transferring from another parish in the diocese?
Name of previous parish (to transfer records)
Are there children under 18 living at this address?

Are there children under 18 living at this address? Yes No
Marital Status
Religion of Spouse
Date/Place of Marriage
Performed By
Spouse's Name Spouse's Name First Middle Last
Spouse's Maiden Name (if applicable) Spouse's Maiden Name (if applicable) First Last
Spouse Address (if different than above) Spouse Address (if different than above)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Spouse's Primary Phone Spouse's Primary Phone - ### - ### ####
Spouse's Secondary Phone Spouse's Secondary Phone - ### - ### ####
Email of Spouse
Birthday of Spouse Birthday of Spouse / MM / DD YYYY
Place of Employment and Phone Number of Spouse

Mary Mother of God - New Parishioner Information

Mary Mother of God - New Parishioner Information

Page 1 of 8 - New Parishioner Information