Cedar Presbyterian Church Membership Questionnaire
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Today's Date
*
Head of Household
Name
*
Maiden Name (if applicable)
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Cell Phone
Home Phone
Email
*
This address will receive a confirmation email
Birthday
*
Anniversary (if applicable)
Occupation
Veteran
Please select one option.
Army
Navy
Air Force
Marines
Coast Guard
Space Force
Previous Home Church
Date Baptized (if known)
Date Professed Faith (if known)
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Other
Spouse (if Applicable)
First & Last Name
Maiden Name (if applicable)
Cell Phone
Email
Birthday
Occupation
Veteran
Please select one option.
Army
Navy
Air Force
Marines
Coast Guard
Space Force
Date Baptized (if known)
Date Professed Faith (if known)
Minor Child #1 (if applicable)
First, Middle & Last Name
Birthday
Current Grade in School
Date Baptized (if known)
Date Professed Faith (if applicable)
Minor Child #2 (if applicable)
First, Middle & Last Name
Birthday
Current Grade in School
Date Baptized (if known)
Date Professed Faith (if applicable)
Minor Child #3 (if applicable)
First, Middle & Last Name
Birthday
Current Grade in School
Date Baptized (if known)
Date Professed Faith (if applicable)
Minor Child #4 (if applicable)
First, Middle & Last Name
Birthday
Current Grade in School
Date Baptized (if known)
Date Professed Faith (if applicable)
Minor Child #5 (if applicable)
First, Middle & Last Name
Birthday
Current Grade in School
Date Baptized (if known)
Date Professed Faith (if applicable)
Any Additional Minor Children
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