Registration and Census
REGISTRATION AND CENSUS
St. Francis de Sales Church
P.O. Box 306 ( Benedict, MD 20612-0306
( New Registration Date form completed
( Update/Correction __________________
MM / DD / YY
Mailing Address:
________________________________________________________________________________________________________
Title First Name Initial Last Name Jr./Sr./etc.
________________________________________________________________________________________________________
Street Address Apt. #
________________________________________________________________
City State ZIP Code
_______________________ _______________________ ______________________________________________
Home Phone Secondary Phone E-mail
__________________________________________________________________________
Street address if different from mailing address
__________________________________________________________________________
Language spoken at home if other than English
________________________________________________________________________________________________________
(Please fill in the information on the back of this form)
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Please indicate the way you want your church envelopes addressed
( Do not publish phone numbers
( Do not publish e-mail
For Office Use Only
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