Saint Nicholas Greek Orthodox Church

PARISH  REGISTRATION FORM

    Member Registering:                                                               Today's Date:

     Name: _______________________________________              Envelope #_______

     Orthodox:  Yes / No                        If no, what religion? _________________________

     Occupation: ____________________        Employer: ________________________   

     Marital Status: __________________

     Address:  _____________________________________________________________

     Phone    Home: _____________   Work: _____________   Cell/Pager: ______________

     Birthday: __________________                                   Nameday: ____________________ 

     Baptismal Date: ________________           

     Wedding Date: _________________

    Spouse:                       

    Name: ___________________________________                       Envelope #_______

    Orthodox:  Yes / No                        If no, what religion? __________________________

    Occupation: ____________________        Employer: _________________________   

     Marital Status: __________________

     Address:  _____________________________________________________________

     Phone    Home: _____________   Work: _____________   Cell/Pager: ______________

     Birthday: __________________                                   Nameday: ____________________ 

     Baptismal Date: ________________           

     Child: Name: ___________________________________               Envelope #_______

      Orthodox:  Yes / No                        If no, what religion? ____________________________

      Birthday: __________________                     Nameday: ____________________ 

      Baptismal Date: ________________           

      Child: Name: ___________________________________               Envelope #_______

      Orthodox:  Yes / No                        If no, what religion? ____________________________

       Birthday: __________________                     Nameday: ____________________ 

       Baptismal Date: ________________           

        Child: Name: ___________________________________              Envelope #_______

        Orthodox:  Yes / No                        If no, what religion? _________________________

        Birthday: __________________                     Nameday: ____________________ 

        Baptismal Date: ________________           

        Child: Name: ___________________________________               Envelope #_______

        Orthodox:  Yes / No                        If no, what religion? _________________________

        Birthday: __________________                      Nameday: ____________________ 

        Baptismal Date: ________________           

         Child: Name: ___________________________________               Envelope #_______

         Orthodox:  Yes / No                        If no, what religion? _________________________

          Birthday: __________________                     Nameday: ____________________ 

          Baptismal Date: ________________           

  FOR OFFICE USE ONLY

  Date Registered: ____________   Meeting with Pastor: ____________  

  Entered on MP: ____________      Letter Mailed: __________