Update Member Information Form • Christian Life Church

First Name *

Middle Name

Last Name *

Suffix

Tip: Use endings like Jr., Sr., II, III only.

Title / Credentials

Tip: Select any that apply (Rev., Dr., etc.).

Gender *

Date of Birth *

Street Address *

City *

State *

Zip Code *

Cell Phone *

Email Address *

Marital Status *

Tip: This helps us understand your household and support you more effectively.

Household / Family Name *

Tip: Usually your last name — for example: Johnson Household.

How would you like your annual household giving statement delivered? *

Send one combined household statement

Send separate statements for each person

Tip: You may choose one combined statement or individual statements.

Wedding Anniversary *

Spouse First Name *

Spouse Middle Name

Spouse Last Name *

Children & Adult Dependents

Tip: Please list any children or adult dependents currently in your household or under your care.

Name of Child/Dependent 1 *

Date of Birth ((Child/Dependent 1) *

Name of Child/Dependent 2

Date of Birth (Child/Dependent 2) *

Name of Child/Dependent 3

Date of Birth (Child/Dependent 3) *

Name of Child/Dependent 4

Date of Birth (Child/Dependent 4) *

Name of Child/Dependent 5

Date of Birth (Child/Dependent 5) *