Membership Information Form
MEMBERSHIP INFORMATION FORM FOR:
Good Shepherd's Ev. Lutheran Church, 1235 S. 100th Street, West Allis, Wisconsin 53214-2502
CHURCH OFFICE PHONE: 414-774-1184
NAME: (First) (Middle) (Last) (Maiden)*
ADDRESS (include city, state, zip):*
TELEPHONE (including area code):
(OPTIONAL) WORK TELEPHONE (including area code):
CELL PHONE #1 (including area code):
Would CELL PHONE #1 like to receive text message updates for CHURCH (texting)?
 YES
 NO
CELL PHONE #2 (including area code):
Would CELL PHONE #2 like to receive text message updates for CHURCH (texting)?
 YES
 NO
EMAIL ADDRESS #1:
EMAIL ADDRESS #2:
PREFERRED METHOD OF CONTACT: (CHECK ALL THAT APPLY)
 HOME PHONE
 CELL PHONE #1
 CELL PHONE #2
 WORK PHONE
 EMAIL ADDRESS #1
 EMAIL ADDRESS #2
PERSONAL INFORMATION FOR CONFIDENTIAL CHURCH RECORDS
DATE OF BIRTH: (MONTH -- DAY -- YEAR)
PLACE OF BIRTH: (CITY, STATE)
FATHER'S NAME: (FIRST) (MIDDLE) (LAST)
MOTHER'S NAME: (FIRST) (MIDDLE) (LAST) (MAIDEN)
DATE OF BAPTISM: (MONTH -- DAY -- YEAR)
NAME OF CHURCH WHERE BAPTIZED:
ADDRESS OF CHURCH WHERE BAPTIZED: (STREET) (CITY) (STATE)
DENOMINATION OF CHURCH WHERE BAPTIZED:
PASTOR'S NAME AT CHURCH WHERE BAPTIZED:
DATE OF CONFIRMATION: (MONTH) (DAY) (YEAR)
NAME OF CHURCH WHERE CONFIRMED:
ADDRESS OF CHURCH WHERE CONFIRMED: (STREET) (CITY) (STATE)
DENOMINATION OF CHURCH WHERE CONFIRMED:
PASTOR'S NAME AT CHURCH WHERE CONFIRMED:
FORMER CHURCH AFFILIATION:
WHAT SYNOD/DENOMINATION WAS YOUR FORMER CHURCH?
WHEN DID YOU LEAVE YOUR LAST CHURCH?
WHY DID YOU LEAVE YOUR LAST CHURCH?
WERE YOU EVER EXCOMMUNICATED?
 YES
 NO
IF SO, WHY WERE YOU EXCOMMUNICATED?
MARRIAGE INFORMATION
__________________________________________
HAVE YOU EVER BEEN MARRIED?
 YES
 NO
ARE YOU PRESENTLY MARRIED?
 YES
 NO
NAME OF CURRENT SPOUSE - IF APPLICABLE: (FIRST) (MIDDLE) (LAST) (MAIDEN)
DATE OF CURRENT MARRIAGE - IF APPLICABLE: (MONTH) (DAY) (YEAR)
NAME OF CHURCH WHERE CURRENT MARRIAGE TOOK PLACE:
ADDRESS OF CHURCH WHERE CURRENT MARRIAGE TOOK PLACE: (STREET) (CITY) (STATE)
DENOMINATION OF CHURCH WHERE CURRENT MARRIAGE TOOK PLACE:
PASTOR'S NAME AT CHURCH WHERE CURRENT MARRIAGE TOOK PLACE:
RELIGION OF YOUR CURRENT SPOUSE:
NAME OF CURRENT SPOUSE'S CHURCH - IF OTHER THAN YOURS:
ADDRESS OF YOUR CURRENT SPOUSE'S CHURCH - IF OTHER THAN YOURS: (STREET) (CITY) (STATE)
IF SPOUSE IS DECEASED, PLEASE ANSWER THE NEXT FIVE QUESTIONS.
NAME OF DECEASED SPOUSE: (FIRST) (MIDDLE) (LAST OR MAIDEN)
DATE OF MARRIAGE TO DECEASED SPOUSE: (MONTH) (DAY) (YEAR)
NAME OF CHURCH WHERE MARRIAGE TO DECEASED SPOUSE TOOK PLACE:
ADDRESS OF CHURCH WHERE MARRIAGE TO DECEASED SPOUSE TOOK PLACE: (STREET) (CITY) (STATE)
DECEASED SPOUSE'S DATE OF DEATH: (MONTH) (DAY) (YEAR)
IF YOU ARE OR WERE DIVORCED, PLEASE ANSWER THE NEXT FIVE QUESTIONS.
NAME OF DIVORCED SPOUSE: (FIRST) (MIDDLE) (LAST OR MAIDEN)
DATE OF MARRIAGE TO DIVORCED SPOUSE: (MONTH) (DAY) (YEAR)
DATE OF DIVORCE FROM DIVORCED SPOUSE: (MONTH) (DAY) (YEAR)
GROUNDS OF DIVORCE FROM DIVORCED SPOUSE:
IF DIVORCED MORE THAN ONCE, PLEASE INCLUDE IDENTICAL INFORMATION FOR EACH FURTHER DIVORCE.
FAMILY RECORD
__________________________________________
(PLEASE LIST ALL CHILDREN WHETHER MEMBERS OR NOT.)
CHILD #1 NAME: (FIRST) (MIDDLE) (LAST)
CHILD #1 BIRTH DATE: (MONTH) (DAY) (YEAR)
CHILD #1 BAPTISM DATE: (MONTH) (DAY) (YEAR)
CHILD #1 CONFIRMATION DATE: (MONTH) (DAY) (YEAR)
CHILD #1 MARRIAGE DATE: (MONTH) (DAY) (YEAR)
CHILD #1 SPOUSE NAME - IF APPLICABLE: (FIRST) (MIDDLE) (LAST)
CHECK THIS BOX IF CHILD #1 IS INCLUDED IN THIS APPLICATION FOR MEMBERSHIP.
CHILD #2 NAME: (FIRST) (MIDDLE) (LAST)
CHILD #2 BIRTH DATE: (MONTH) (DAY) (YEAR)
CHILD #2 BAPTISM DATE: (MONTH) (DAY) (YEAR)
CHILD #2 CONFIRMATION DATE: (MONTH) (DAY) (YEAR)
CHILD #2 MARRIAGE DATE: (MONTH) (DAY) (YEAR)
CHILD #2 SPOUSE NAME - IF APPLICABLE: (FIRST) (MIDDLE) (LAST)
CHECK THIS BOX IF CHILD #2 IS INCLUDED IN THIS APPLICATION FOR MEMBERSHIP.
CHILD #3 NAME: (FIRST) (MIDDLE) (LAST)
CHILD #3 BIRTH DATE: (MONTH) (DAY) (YEAR)
CHILD #3 BAPTISM DATE: (MONTH) (DAY) (YEAR)
CHILD #3 CONFIRMATION DATE: (MONTH) (DAY) (YEAR)
CHILD #3 MARRIAGE DATE: (MONTH) (DAY) (YEAR)
CHILD #3 SPOUSE NAME - IF APPLICABLE: (FIRST) (MIDDLE) (LAST)
CHECK THIS BOX IF CHILD #3 IS INCLUDED IN THIS APPLICATION FOR MEMBERSHIP.
CHILD #4 NAME: (FIRST) (MIDDLE) (LAST)
CHILD #4 BIRTH DATE: (MONTH) (DAY) (YEAR)
CHILD #4 BAPTISM DATE: (MONTH) (DAY) (YEAR)
CHILD #4 CONFIRMATION DATE: (MONTH) (DAY) (YEAR)
CHILD #4 MARRIAGE DATE: (MONTH) (DAY) (YEAR)
CHILD #4 SPOUSE NAME - IF APPLICABLE: (FIRST) (MIDDLE) (LAST)
CHECK THIS BOX IF CHILD #4 IS INCLUDED IN THIS APPLICATION FOR MEMBERSHIP.
CHILD #5 NAME: (FIRST) (MIDDLE) (LAST)
CHILD #5 BIRTH DATE: (MONTH) (DAY) (YEAR)
CHILD #5 BAPTISM DATE: (MONTH) (DAY) (YEAR)
CHILD #5 CONFIRMATION DATE: (MONTH) (DAY) (YEAR)
CHILD #5 MARRIAGE DATE: (MONTH) (DAY) (YEAR)
CHILD #5 SPOUSE NAME - IF APPLICABLE: (FIRST) (MIDDLE) (LAST)
CHECK THIS BOX IF CHILD #5 IS INCLUDED IN THIS APPLICATION FOR MEMBERSHIP.
ADDITIONAL CHILD INFORMATION YOU WISH TO INCLUDE:
CHURCH OFFICES YOU HAVE HELD/ORGANIZATIONS IN WHICH YOU HAVE PARTICIPATED:
YOUR CURRENT OCCUPATION:
IF RETIRED, YOUR FORMER OCCUPATION:
YOUR SPECIAL INTERESTS: PLEASE LIST HERE ANY AREAS OF SPECIAL INTEREST IN WHICH YOU WOULD BE WILLING TO HELP AT GOOD SHEPHERD'S.
STATEMENT OF INTENTION (PART 1): I HEREBY STATE THAT I AM FULL IN AGREEMENT WITH THE REQUIREMENTS OF CHURCH MEMBERSHIP AS STATED IN THE CONSTITUTION OF GOOD SHEPHERD'S EV. LUTHERAN CHURCH, ARTICLE V.*
STATEMENT OF INTENTION (PART 2): I AM NOT A MEMBER OF ANY MASONIC LODGE OR AUXILIARY, OR ANY OTHER LODGES, SECRET SOCIETIES, OR ANTI-CHRISTIAN ORGANIZATIONS, WHOSE TEACHINGS CONFLICT WITH THE WORD OF GOD.*
STATEMENT OF INTENTION (PART 3): I DO INTEND, WITH GOD'S HELP, TO MAKE FAITHFUL USE OF GOD'S WORD AND SACRAMENTS AND TO SERVE MY SAVIOR TO THE BEST OF ALL MY ABILITIES AS A MEMBER OF GOOD SHEPHERD'S EV. LUTHERAN CHURCH.*
DATE OF THIS APPLICATION: (MONTH) (DAY) (YEAR)
THIS SPACE IS PROVIDED FOR INCLUSION OF ANY ADDITIONAL INFORMATION YOU WISH TO PROVIDE.
THANK YOU FOR COMPLETING THIS INFORMATION FORM FOR OUR RECORDS.


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For God so loved the world that he gave his one and only Son. ~ JOHN 3:16