Welcome to our Church. Visit our web site at www.ourladyoflourdesdaytona.com for
 more information.

Click Submit Form to send this information to Our Lady Of Lourdes Parish.

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*Registration Option Register a New Family Update an Existing Family *ID/Env:  

Head of Household
*Title *First Name *Last Name Suffix
Relationship   Middle Name
*Birth Date *Gender Female   Male
  Language Marital Status
*Phone 1 ( ) - Unlisted
  Phone 2 ( ) - Unlisted
  Email 1   Unlisted
Send Email Instead of Mail When Possible
  Email 2   Unlisted
Send Email Instead of Mail When Possible

Spouse
Title   First Name   Last Name Suffix
Relationship   Middle Name   Nickname Maiden Name
Ethnicity   Birth Date   Gender Female   Male
Grade/Degree   Language Marital Status
  Phone 1 ( ) - Unlisted
  Phone 2 ( ) - Unlisted
  Email 1   Unlisted
Send Email Instead of Mail When Possible
  Email 2   Unlisted
Send Email Instead of Mail When Possible

Family Street Address
*Line 1
  Line 2
*City
*State
*ZIP

Family Mailing Address
  Line 1
  Line 2
  City
  State
  ZIP

Family Alternate Address
  Line 1
  Line 2
  City
  State
  ZIP

Family Phone Numbers
*Primary ( ) - Unlisted
  Other ( ) - Unlisted
Email
*Email   Unlisted
Send Email Instead of Mail When Possible

Member 1   Type  
Title   First Name   Last Name Suffix
Relationship   Middle Name   Nickname Maiden Name
Ethnicity   Birth Date   Gender Female   Male
Grade/Degree   Language Marital Status
  Phone 1 ( ) - Unlisted
  Phone 2 ( ) - Unlisted
  Email 1   Unlisted
Send Email Instead of Mail When Possible
  Email 2   Unlisted
Send Email Instead of Mail When Possible


Click Submit Form to send this information to Our Lady Of Lourdes Parish.

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