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Registration

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  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Date REQUIRED Please fill out this field. Please enter a date.
  
  Title
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  
  Type of phone number
  
  Date of Birth Please enter valid data.
  
  Marital Status Please enter valid data.
  
  Gender
  
  Ethnicity (for demographic purposes), check all that apply: Asian Black Latino Middle Eastern Native American White
  
  IU Affiliation
  
  Would you like to receive donation envelopes?
  
  Would you like to enroll in Electronic Fund Transfer (EFT)?
  
  The following questions allow us to maintain your information as a registered parishioner if in the future you require documentation or proof of having received certain sacraments. They are optional.
  
  Are you baptized?
  
  Date of Baptism Please enter valid data.
  
  Church of Baptism Please enter valid data.
  
  Have you received First Communion?
  
  Date of First Communion Please enter valid data.
  
  Church of First Communion Please enter valid data.
  
  Have you received Confirmation?
  
  Date of Confirmation Please enter valid data.
  
  Church of Confirmation Please enter valid data.
  
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