New Member Form
Please fill out this form and click submit.
Welcome new member!
Only fill out the sections which apply to your household below; leave extra sections blank. If there are more than five members of your household, you may write in additional family members info in the text box at the bottom. Thank you!
Household Mailing Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Physical Address (if different)
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Phone
*
Email
*
This address will receive a confirmation email
Individual Information
Personal Email Address (if different)
First, Middle, Last Name
*
Maiden Name
Family Relation (Wife/Husband/Child)
Gender
Marital Status
Cell Phone #
Birth Date, Birth City
Baptism Date, Baptism Church/City/State
Confirmation Date, Confirmation Church/City/State
Marriage Date, Marriage Church/City/State
Individual Information
Email Address
First, Middle, Last Name
Maiden Name
Family Relation (Wife/Husband/Child)
Gender
Marital Status
Cell Phone #
Birth Date, Birth City
Baptism Date, Baptism Church/City/State
Confirmation Date, Confirmation Church/City/State
Marriage Date, Marriage Church/City/State
Child
First, Middle, Last Name
Gender
Birth Date, Birth City
Baptism Date, Baptism Church/City/State
Confirmation Date, Confirmation Church/City/State
Media Release: We may share appropriate photos or videos of your child participating in our program to tell the story of our church on social media. If you have concerns with this, please reach out to Anna Wencl (annawencl@blcmankato.org)
Please select one option.
I understand
Child
First, Middle, Last Name
Gender
Birth Date, Birth City
Baptism Date, Baptism Church/City/State
Confirmation Date, Confirmation Church/City/State
Media Release: We may share appropriate photos or videos of your child participating in our program to tell the story of our church on social media. If you have concerns with this, please reach out to Anna Wencl (annawencl@blcmankato.org)
Please select one option.
I understand.
Child
First, Middle, Last Name
Gender
Birth Date, Birth City
Baptism Date, Baptism Church/City/State
Confirmation Date, Confirmation Church/City/State
Media Release: We may share appropriate photos or videos of your child participating in our program to tell the story of our church on social media. If you have concerns with this, please reach out to Anna Wencl (annawencl@blcmankato.org)
Please select one option.
I understand.
Additional Members:
Please include information about additional household members here:
Communications
Communications
Please select all that apply.
I would like to receive the BLC Weekly email
I would like to receive the monthly newsletter, the Bethlehem Star
Submit
Description
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