Bright Star Community Church Membership Information Form
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Email *
First Name *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Date of Membership *
MM
/
DD
/
YYYY
Spouse's First Name
Spouse's Last Name
Spouse's Date of Birth
MM
/
DD
/
YYYY
Spouse's Date of Membership
MM
/
DD
/
YYYY
Wedding Anniversary Date
MM
/
DD
/
YYYY
Street Address *
City *
State *
Zip Code *
Phone (Home)
Phone (Cell)
Phone (Work)
Permission to include phone numbers (s) in Church Directory?
Email Address
DEPENDENTS (Living in Your Home)
This section is to be completed for dependents/minors that are living in the home with you. Please complete each section for each dependent/minor.
Dependent #1
This section is to be completed for dependent/minor #1
First Name
Last Name (if different from above)
Date of Birth
MM
/
DD
/
YYYY
Date of Membership
MM
/
DD
/
YYYY
Gender
Dependent #2
This section is to be completed for dependent/minor #2
First Name
Last Name (If different from above)
Date of Birth
MM
/
DD
/
YYYY
Date of Membership
MM
/
DD
/
YYYY
Gender
Dependent #3
This section is to be completed for dependent/minor #3
First Name
Last Name (If different from above)
Date of Birth
MM
/
DD
/
YYYY
Date of Membership
MM
/
DD
/
YYYY
Gender
Dependent #4
This section is to be completed for dependent/minor #4
First Name
Last Name (If different from above)
Date of Birth
MM
/
DD
/
YYYY
Date of Membership
MM
/
DD
/
YYYY
Gender
Dependent #5
This section is to be completed for dependent/minor #5
First Name
Last Name (If different from above)
Date of Birth
MM
/
DD
/
YYYY
Date of Membership
MM
/
DD
/
YYYY
Gender
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