EmailMe Form - Bethel United Methodist Church

EmailMeForm

Family Name
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Home Phone
### - ### - ####
Is your phone number unlisted?
Family Email
May we add it to our email blast list?
Emergency Contact #1
(if different than those listed below)
First Last
Emergency Contact #1 Phone Number
### - ### - ####
Emergency Contact #2
(if different than those listed below)
First Last
Emergency Contact #2 Phone Number
### - ### - ####
PERSON #1 Individual Information
please complete the next section for person #1
Last Name (if different)
First Name
Middle Initial
Title
Nick Name
Birth Date
MM / DD / YYYY
Work Phone
### - ### - ####
Cell Phone
### - ### - ####
Personal Email
Relationship to Bethel
Date Joined
MM / DD / YYYY
Date Baptized
MM / DD / YYYY
Date Confirmed
MM / DD / YYYY
Marital Status
Date Married
MM / DD / YYYY
PERSON #2 Individual Information
please complete the next section for person #2
Last Name (if different)
First Name
Middle Initial
Title
Nick Name
Birth Date
MM / DD / YYYY
Work Phone
### - ### - ####
Cell Phone
### - ### - ####
Personal Email
Relationship to Bethel
Date Joined
MM / DD / YYYY
Date Baptized
MM / DD / YYYY
Date Confirmed
MM / DD / YYYY
Marital Status
Date Married
MM / DD / YYYY
Additional Family Members
Please list the names of all children or immediate family members in this household.
Child/Family Member #1
First Last
Birth Date
MM / DD / YYYY
Child/Family Member #2
First Last
Birth Date
MM / DD / YYYY
Child/Family Member #3
First Last
Birth Date
MM / DD / YYYY
Child/Family Member #4
First Last
Birth Date
MM / DD / YYYY
Additional Family Members or Information:
Online Directory
Bethel Church maintains a password protected online directory of church members and would like to keep it up-to-date for members use. Feel free to contact the church office for more information concerning the online directory.
Can we include/update your family information on our online directory?
Family Picture
Please attach a recent family portrait that we can also include in the online directory.
Thank you!
After entering the image verification and clicking "submit" below you will be redirected to our church website: bethellewes.org
Image Verification

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PERSON #1 Individual Information

PERSON #2 Individual Information

Additional Family Members

Online Directory

Thank you!