Change of Personal Information for Members

Have you moved lately? Does FMBC have your updated information? If not please take some time to fill out this form so that our records accurately reflect all information pertaining to the member.

ARE YOU A MEMBER?

Yes No

FIRST NAME

Last Name

Name Change

First Name

Last Name

Marriage

Old Address

Address

City

Zip

New Or Current Address

Address

City

Zip

Birth Date

Anniversary Date

Old Phone Number

New Phone Number

Old Email

New or Current Email

List all names of family members in relation to you. (Ex. Barbara Doe - Wife, Sarah Doe - Daughter)

Which service do you attend?

0800 1045

Do You know who your Deacon is?

Yes No

If yes, please enter his name

OTHER INFORMATION

Age

Gender

Ethnicity

Are you married ?

Yes No

What county do you live in?

Any additional Information that we need to know?