StS MARY AND EDWARD CATHOLIC CHURCH

611 N.Main Street ,Roxboro,NC 27573

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Parishioner Update or Registration Form

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Registration Form
The maximum number of form submissions has been reached. This form is currently not available.
- If you are currently a parishioner and any of your (or your family''s) information on file with us has changed, please complete and submit the form below so that we can update our records. If you have added a family member, be sure and let us know his/her full name, gender, and date of birth.Also you can register as new member online
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
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  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Update or New Register REQUIRED Please fill out this field.
- Names and DOB new members REQUIRED Please fill out this field.
- Date REQUIRED Please fill out this field. Please enter a date.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone REQUIRED Please fill out this field. Please enter valid data.
- Comments REQUIRED Please fill out this field.
- I Agree Please select this field.
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