Application for Membership at Baselios Church

Fields marked with blue are required. Others are optional.
Membership Type
Must Choose 1
FULL - Eligible to participate in the management
of the church. Archdiocesan annual contribution and
minimum financial support of Baselios Church is required.
*
STUDENT -Full Time Student in a Financial Institution
ASSOCIATE - Not eligible to participate in the management
of the church. No financial commitment is required.

Information About You

Full Name *
Address *
City *
State *
Zip Code *
Country
Telephone No: *
Telephone No (Cell)
Other Phone No:
email address *
Repeat email address *
Date of Birth Month: Date: Year (4 digits., eg. 1975):
Your Occupation (Profession)
Home Parish Info
(Church Name, City,
State, Country)
Baptism Info
(Date of Baptism, Name, City,
State and Country of Church
where baptism was held)
Gender *
Your Age
Marital Status *
No of children *
Educational Institution Info
(For Student Members Only)

Information About Your Spouse

Skip this section if you do not have a spouse.

Full Name of your spouse *
Your spouse's Profession
Spouse Date of Birth Month: Date: Year (4 digits., eg. 1975):
Spouse Phone
Spouse Cell Phone
Spouse email address *
Spouse email address
(Repeat)
*
Spouse Home Parish Info
(Church Name, City,
State, Country)
Spouse Baptism Info
(Date of Baptism, Name, City,
State and Country of Church
where baptism was held)
Marriage Date Month: Date: Year (4 digits., eg. 1975):
Marriage Held at:
(Name of church, city,
state, Country)
Information About Your Children

Skip this section if you do not have any children. Otherwise fill in the info for your children

Information About Child #1
Full Name *
Gender *
Date of Birth Month: Date: Year (4 digits., eg. 1975):
Child Baptism Info
(Date of Baptism, Name, City,
State and Country of Church
where baptism was held)
Information About Child #2
Full Name *
Gender *
Date of Birth Month: Date: Year (4 digits., eg. 1975):
Child Baptism Info
(Date of Baptism, Name, City,
State and Country of Church
where baptism was held)
Information About Child #3
Full Name *
Gender *
Date of Birth Month: Date: Year (4 digits., eg. 1975):
Child Baptism Info
(Date of Baptism, Name, City,
State and Country of Church
where baptism was held)
Information About Child #4
Full Name *
Gender *
Date of Birth Month: Date: Year (4 digits., eg. 1975):
Child Baptism Info
(Date of Baptism, Name, City,
State and Country of Church
where baptism was held)
Information About Child #5
Full Name *
Gender *
Date of Birth Month: Date: Year (4 digits., eg. 1975):
Child Baptism Info
(Date of Baptism, Name, City,
State and Country of Church
where baptism was held)
Information About Child #6
Full Name *
Gender *
Date of Birth Month: Date: Year (4 digits., eg. 1975):
Child Baptism Info
(Date of Baptism, Name, City,
State and Country of Church
where baptism was held)
Thank you.
Now click on "Register Me" button below so we will enter your application



Your registration is not complete until you click on this

 

-------
Copyright 2009-2014 - St. Basil's Syriac Orthodox Church, Cleveland, Ohio. All Rights Reserved.
Website designed, built, and hosted by International Cyber Business Services, Inc., Hudson, Ohio