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* EmployerOccupationDate 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.
