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.
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