Member Information Update

Regardless if you have recently joined our church or are a long-time member, please complete this form to keep us up to date with your latest information. Please complete all applicable fields.

Note: This form is for congregations’ use. Contact our pastors jay.barnes@fumclib.org or seann.duffin@fumclib.org concerning membership and discipleship.

Date Joined:

How joined (select one):

Please enter first and last name of the first adult:

Choose one:

First Adult Name:

Date of birth:

Choose one:

Please enter the first and last name of the second adult:

Choose one:

Second Adult Name:

Date of birth:

Choose one:

Mailing address:

Email address:

Wedding anniversary:

Please complete the names of each child:

Child one:

Baptized?

Birthday:

Child two:

Baptized?

Birthday:

Child three:

Baptized?

Birthday:

Please enter verification code displayed below. Please pay attention to upper and lower case letters. This form will not be submitted unless the proper code is entered.

Verification