Grace Evangelical Lutheran Church

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First Name

Nick Name

Middle Name

Last Name

Address

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Home Phone

Work Phone

Mobile Phone

Birthday

I am a member of this church

Member Since (4 Digit Year)

Spouse's Name

Children Names and Birth Date

e.x. Joe Smith (10/11/2003), Katie Smith (1/1/2004)

Profession

Skills and Interests

Comments

Grace Evangelical Lutheran Church, Middletown, CT