Membership Application Form

Vailankanni Arockia Madha Catholic Community (VAMCC)

I. Member Information

First Name *

Middle Name

Last Name *

Maiden Name

Date of Birth

Gender

Male

Female

II. Contact Details

Street Address

City

State

ZIP Code

Country

Home Phone

Mobile Phone

Email Address *

III. Spiritual & Sacramental History

Are you a baptized Roman Catholic?

Yes

Other Sacraments Received

First Communion / Eucharist

Confirmation

First Penance

Do you need instruction for any sacraments?

Yes

IV. Church Involvement

Current Parish Name

Parish City & State

Previously registered in another parish?

Yes

V. Interests and Skills

Volunteer Interests

Community Outreach

Fundraising

Event Planning

Youth Ministry

Religious Education

Administration

Other

Skills/Occupation

Why do you want to become a member?

How Do You Prefer to Contribute?

Electronic Donations

Matching Gifts

IRA

Planned Giving

Other

VI. Family Information

Marital Status

Spouse Name

Spouse Catholic?

Yes

Children

Name

Date of Birth

Catholic?

VII. Terms & Conditions

By signing below, I certify that the information provided in this form is true, accurate, and complete to the best of my knowledge

I agree to the Terms and Conditions *

Signature

Date