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RCIA Registration

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  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Current Religious Affiliation REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  City, State of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Religion REQUIRED Please fill out this field. Please enter valid data.
  
  If you are baptized, please provide the following:
  
  Name of Church Please enter valid data.
  
  City, State of Church Please enter valid data.
  
  Date of Baptism Please enter valid data.
  
  Minister of Baptism Please enter valid data.
  
  If you are currently married, please provide the following:
  
  Name of Spouse Please enter valid data.
  
  Spouse's Religion Please enter valid data.
  
  Date of Marriage Please enter valid data.
  
  Minister Please enter valid data.
  
  Name and Place of Marriage Please enter valid data.
  
  City, State Please enter valid data.
  
  Prior to this marriage, were you married to another person? Yes No
  
  If you answerd yes to the previous question,what is the total number of times you have been married (including your current marriage)? Please enter valid data.
  
  Prior to this marriage, was your spouse married to another person? Yes No
  
  If you answerd yes to the previous question, what is the total number of times your spouse been married (including your current marriage)? Please enter valid data.
  
  If you are not currently married, please provide the following:
  
  Have you ever been married (church, civil, common-law)? Yes No
  
  If yes, how many times have you been married? Please enter valid data.
  
  Prior religious experience Please enter valid data.
  
  Reason for wanting to become Catholic Please enter valid data.
  
  Any specific questions you have or would like to see addressed
  
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