Parish Registration

Thanks for taking a moment to register your household's information with our parish's office. Please fill out the form as completely as possible and then click submit. If you wish, you can also register in person at the Parish Office or via phone at 505-247-4271.

Name

Title

First Name*

Last Name*

Birthday

Required* //

Occupation

Married?

Check here if Married.

Married?

Name of Spouse or Significant Other

Title

First Name

Last Name

Spouse or Significant Other's Birthday

First and Last Name(s) of Other Adult(s) in Household

First and Last Names of Child(ren) in Household

Please provide birth dates (day, month, and year) for each child as well.

Primary Phone

Required* --

Secondary Phone

Email Address

Required*

Alternative Email Address

Home Address

Street 1*

Street 2

City*

State*

Zip*

Other Preferred Means of Communication? Please list here.

Is this information:
Required*

	Brand New Information?
	An Update to a Current Household Listing?

Registered at ICC Before?

Check here if you have been registered at Immaculate Conception Church in the past.

Previously Registered

To which other parish(es) do you belong?

Please provide the name and location (city and state).

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Parish Registration

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