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First Name: Last Name: Home Number: Cell Number: Address: Gender: - MaleFemale Church: - [St.Mina] Calgary - AB[St. Mary or St. Mark] Edmonton - AB[St. Mark] Winnipeg - MB[St. Mary & St. George] Vancouver - BC[St. Mary] Lynnwood - WA[St. George] Redmond - WA[St. Mark] Puyallup - WA[St. Antonious] Portland - OR[Virgin Mary & St. Mark] Boise - IDOther Emergency Contact Name: Emergency Contact Number: Health Care Provider: Health Care Number: Birthday (M/D/Y): Email Address: Couple(Yes/No/NA) Comment: Security number: Enter the number displayed above