St. Columba's Episcopal Church

Member Registration Form

4201 Albemarle Street NW
Washington, D.C. 20016
202-363-4119 (phone)
202-686-2671 (fax)

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EmailMeForm

How many Adults are interested in membership from your household?

One Adult

Two Adults
Adult 1 Information

Please complete the following information for the first adult interested in membership.
Name *
Prefix First Last Suffix
Date of Birth *
MM / DD / YYYY
Nickname
Previous Name (if baptized under another name)
Date of Baptism
MM / DD / YYYY
Place of Baptism (Parish (if known), City, State, Country)
Marital Status
Current Mailing Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Home Phone
### - ### - ####
Work Phone
### - ### - ####
Cell Phone
### - ### - ####
Preferred Method of Contact

Phone

Email
Most Recent Church Membership (if any). Please include Church Name, City and State
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Member Registration Form