NEW MEMBER REGISTRATION FORM

Name (Member 1)*
Prefix First Last
Birthdate*
Date Format: MM slash DD slash YYYY
Occupation
- Current
- Retired/Former
Email*
Cell Phone*
Name (Member 2)
Prefix First Last
Birthdate
Date Format: MM slash DD slash YYYY
Occupation
- Current
- Retired/Former
Email
Cell Phone
Home Phone*
Florida Address*
Street Address Address Line 2 City ZIP Code
Secondary Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
If seasonal, what months do you live in Florida?
Marital Status
- Single
- Married
- Partnered
- Engaged
- Divorced
- Widowed
If "Married" is selected above, Date of Marriage:
Date Format: MM slash DD slash YYYY
Would you like offering envelopes?
Please list any children's names and ages, if applicable (ie. John Smith, age):
Interest in Sunday's infant nursery, children, and youth programs?
Emergency Contact
Relationship
Address
City State / Province / Region ZIP / Postal Code
Phone
Email
How would you like to join Naples United Church of Christ?
- Associate Member (this allows you to retain your full membership elsewhere)
- Full Member (Full members of NUCC, but also members of another church)
- Transfer Letter
- Re-affirmation of Faith (member of a church, but attends/participates rarely)
- Profession of Faith (non-member or inactive member of a church)
Date you wish to join:
Date Format: MM slash DD slash YYYY
- I prefer to joining now (without congregational acknowledgement)
Name of Member 1, as you would like it to appear on your name tag:*
Magnet or pinned (pacemaker friendly) name tag?*
Name of Member 2 (if applicable), as you would like it to appear on your nametag:
Magnet or pinned (pacemaker friendly) name tag?

NEW MEMBER REGISTRATION FORM

How would you like to join Naples United Church of Christ?