Member Profile Sheet Please respond N/A for fields that do not apply. "*" indicates required fields Member InformationDate Joined Month Day Year NameLast* First* M.I.* Preferred Name* Address* Apt. # City* State* Zip Code*Home Phone*Cell Phone*Work Phone*Email* Employer Occupation Date of Birth* MM slash DD slash YYYY Anniversary Date MM slash DD slash YYYY Date of Baptism* MM slash DD slash YYYY Gender*MaleFemaleMarital Status*MarriedSingleDivorcedWidowSeparatedRace*African AmericanCaucasianHispanicOtherOther* CMBC members who are in your household*Emergency Contact InformationName* Emergency Contact Phone*Relationship* PhoneThis field is for validation purposes and should be left unchanged.
