Bethel Baptist Church

Please note that in our Directory, only your names, address, and home phone number are listed in the directory. This directory is only provided to church members and regular attenders, not to the general public. All other information you provide on this form will remain private and only be used for church communications.

Date:

Member Status:

Name:

Date of Birth:

Street Address:

City, State, Zip:

Home Phone #: Work Phone #: Cell Phone #:

May we use your Work Phone # to contact you, if neccessary?

May we use your Cell Phone # to contact you, if neccessary?

Email:

FAMILY INFORMATION:
(Please provide information for any other family members who live at the same address listed above. For any family at a different address, please fill out a separate form.)

Spouse Name: Spouse Date of Birth:

Child 1 Name: Child 1 Date of Birth:

Child 2 Name: Child 2 Date of Birth:

Child 3 Name: Child 3 Date of Birth:

Child 4 Name: Child 4 Date of Birth:

Child 5 Name: Child 5 Date of Birth:

Child 6 Name: Child 6 Date of Birth: