Directory/Breeze  Update
Please help us stay connected by updating the information below. (Only your name(s), address, email address(es), and phone number(s) will be shared on the password-protected page of our website, for other congregants to keep in touch. Only key staff members and leaders will have access to other information, in our Breeze database.) Thank you!
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Email *
Name *
Name of 2nd Person (if applicable)
Name (as you want it to appear in the Directory) *
Address
City, State, Zip
Email (Person 1)
Email (Person 2)
Home Phone Number
Cell Phone Number (Person 1)
Cell Phone Number (Person 2)
Preferred Method of Contact
Clear selection
Birth Date (Person 1)
Birth Date (Person 2)
Gender (Person 1)
Gender (Person 2)
Pronouns (Person 1)
Clear selection
Pronouns (Person 2)
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Do you identify as ... (Person 1)  Please choose ALL that apply (Need for UUA Recertification) *
Required
Do you identify as ... (Person 2)  Please choose ALL that apply (Need for UUA Recertification)
Marital Status
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Please list children's names and birthdates if applicable.
Emergency Contact Name
Emergency Contact Email
Emergency Contact Phone
(Non-Members) Are you interested in becoming a member?
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Is there anything else you'd like to add?
Submit
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