Please help us maintain accurate records.

Contact Information

Name *

First

Last

Birthdate

Home Phone (numbers only)

Cell Phone (numbers only)

Preferred contact

Home
Cell

Email

Confirm Email

Please add me to the automated calling system

Home Phone
Cell Phone
Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Please send me the church newsletter

Email
Physical Mail

Membership information

Transfer

In
Out

Transfer date

Church name and address

Discipleship and Leadership

My gifts and abilities

Where I'd like serve or help

Emergency Information

My water is

Municipal
Well
Other

I have a generator

Yes
No

I need oxygen

Yes
No

Critical Medications

How many are in my household?

Anything else we need to know?

Please help us maintain accurate records.

Contact Information

Membership information

Discipleship and Leadership

Emergency Information

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South Hill United Methodist Church