Parish Registration

Thank you for registering at Immaculate Conception Church. We are happy that you have decided to become a member of our vibrant faith community located here in downtown Albuquerque!

If you have any questions please call the office at 505-247-4271

You may also email Kimberly at: kjarnagin@iccabq.org

Name

First Name*

Last Name*

Birthday

Required* //

Occupation

Married?

Check here if Joint Household.

Joint Household?

Name of Spouse or Significant Other

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?

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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