Member Registration Form

Christ The King Anglican Church

3850 West Anthony Road

Ocala, Florida 34475

(352) 351-9727

(352) 351- 9760 (fax)

(Please Print)

Date:______________________________

Last Name:___________________________________________________________________________

First:____________________________________Middle:______________________________________

Title: (Mr., Mrs., Miss., Ms., Dr., Fr.)_________________

Goes By:_______________________________________

Address:_____________________________________________________________________________

City:__________________________________________State:__________________Zip:____________

Home Phone:______________________________ Work Phone:_________________________

Cell Phone:________________________________Email:_______________________________

Date of birth:______________________________ If married, anniversary date:___________________

Single:_____________ Married:_______________ Divorced:_____________ Widow (er)____________

Baptized? Yes__________ No___________ Date:_______________________________

Confirmed? Yes_________ No___________ Date:_______________________________

Spouse’s Last Name:_______________________________________________________

First:_________________________________Middle:____________________________

Title: (Mr., Mrs., Dr., Fr.)________________________

Goes By: ________________________________________________________________

Work Phone:__________________________ Cell Phone:_________________________

Email:___________________________________________________________________

Date of birth:______________________________

Do you wish to transfer your membership to Christ The King Anglican Church? Yes________No_______

Name and address of former church you wish to transfer from:__________________________________

_____________________________________________________________________________________

If you have no church affiliation, do you wish to join Christ the King Anglican Church?________________

CHILDREN:

Last Name:____________________________________________________________

First Name____________________________Middle___________________________

Goes by:______________________________

Date of birth:__________________________Baptized?__________________Date:_________________

Confirmed?___________________ Date:___________________

Last Name:____________________________________________________________

First Name____________________________Middle___________________________

Goes by:______________________________

Date of birth:__________________________Baptized?__________________Date:_________________

Confirmed?___________________ Date:___________________

Last Name:____________________________________________________________

First Name____________________________Middle___________________________

Goes by:______________________________

Date of birth:__________________________Baptized?__________________Date:_________________

Confirmed?___________________ Date:___________________