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*Name:
*Email Address:
*Family Name:
*Address:
*City:
*State:
*Zip Code:
*Phone:
*Status:	Single Married Separated Divorced Window Widower
If Married, Date Married:
If Married, Place:
If Married, Wife
*Family Member 1:
*Date of Birth 1:
*Baptised 1:	Yes No
*Communion 1:	Yes No
*Confirmation 1:	Yes No
*Other Religion 1:
Family Member 2:
Date of Birth 2:
Baptised 2:	Yes No
Communion 2:	Yes No
Confirmation 2:	Yes No
Other Religion 2:
Family Member 3:
Date of Birth 3:
Baptised 3:	Yes No
Communion 3:	Yes No
Confirmation 3:	Yes No
Other Religion 3:
Family Member 4:
Date of Birth 4:
Baptised 4:	Yes No
Communion 4:	Yes No
Confirmation 4:	Yes No
Other Religion 4:
Family Member 5:
Date of Birth 5:
Baptised 5:	Yes No
Communion 5:	Yes No
Confirmation 5:	Yes No
Other Religion 5:
Family Member 6:
Date of Birth 6:
Baptised 6:	Yes No
Communion 6:	Yes No
Confirmation 6:	Yes No
Other Religion 6:
* fields are required