Survey - Online New Member Registration Form

Online New Member Registration Form

Thank you for taking the time to complete your New Member Registration Form for The Basilica of Saint Mary in Minneapolis, Minnesota.

In general, what prompted you to join The Basilica parish community at this time? (Select one of the available choices or enter a different value.) In general, what prompted you to join The Basilica parish community at this time? Click this to indicate that you will select an existing value. Tab to next input." In general, what prompted you to join The Basilica parish community at this time? In general, what prompted you to join The Basilica parish community at this time? Click this to indicate that you will enter a new value. Tab to next input." In general, what prompted you to join The Basilica parish community at this time? Provide your answer here

If other, please share additional information (Maximum response 255 chars, approx. 5 rows of text)

Personal Information

Complete Information Below

Field Is Required Title

Field Is Required First

Middle

Field Is Required Last

Suffix

Field Is Required Date of Birth:

Field Is Required Gender:

Field Is Required Street 1:

Field Is Required City/Town:

Field Is Required State / Province:

Field Is Required ZIP / Postal Code:

Country:

Field Is Required Email:

Field Is Required Phone Number:

If you respond and have not already registered, you will receive periodic updates and communications from The Basilica of Saint Mary.

Email Format:

Keep me logged in. What's this?

Maiden Name

Field Is Required Marital Status

Field Is Required Religion

Ethnicity

First Spoken Language

Second Spoken Language

Business Information

Profession

Employer Name

Business Address (Maximum response 255 chars, approx. 5 rows of text)

Business City

Business State/Province

Business Zip

Business Phone

Sacramental Information

Please complete all information to the best of your ability. If you are not sure of your sacramental dates, provide as much information as you can accurately recall.

Baptism Date, if known

Baptism Church Name

Baptism City, State

First Communion Date, if known

First Communion Church Name

First Communion City, State

First Reconciliation Date, if known

First Reconciliation Church Name

First Reconciliation City, State

Confirmation Date, if known

Confirmation Church Name

Confirmation City, State

Marriage Date

Marriage Church Name

Marriage City, State

Additional Household Members

Do you have a spouse or additional adult living in your household?

Spouse/Second Adult Information

Relationship to Head of Household

Spouse/Second Adult Title

Spouse/Second Adult First Name

Spouse/Second Adult Middle Name/Initial

Spouse/Second Adult Last Name

Spouse/Second Adult Suffix

Spouse/Second Adult Nickname

Spouse/Second Adult Maiden Name

Spouse/Second Adult Birthdate

Spouse/Second Adult Gender

Spouse/Second Adult Ethnicity

Spouse/Second Adult Marital Status

Spouse/Second Adult First Language Spoken

Spouse/Second Adult Second Language Spoken

Spouse/Second Adult Religion

Spouse/Second Adult Email

Spouse/Second Adult Home Phone

Spouse/Second Adult Mobile Phone

Spouse/Second Adult Business Information

Spouse/Second Adult Spouse/Second Adult Profession

Spouse/Second Adult Employer Name

Spouse/Second Adult Business Address (Maximum response 255 chars, approx. 5 rows of text)

Spouse/Second Adult Business Phone

Spouse/Second Adult Sacramental Information

Please complete all information to the best of your ability. If you are not sure of your sacramental dates, provide as much information as you can accurately recall.

Spouse/Second Adult Baptism Date, if known

Spouse/Second Adult Baptism Church Name

Spouse/Second Adult Baptism City, State

Spouse/Second Adult First Communion Date, if known

Spouse/Second Adult First Communion Church Name

Spouse/Second Adult First Communion City, State

Spouse/Second Adult First Reconciliation Date, if known

Spouse/Second Adult First Reconciliation Church Name

Spouse/Second Adult First Reconciliation City, State

Spouse/Second Adult Confirmation Date, if known

Spouse/Second Adult Confirmation Church Name

Spouse/Second Adult Confirmation City State

Spouse/Second Adult Marriage Date

Spouse/Second Adult Marriage Church Name

Spouse/Second Adult Marriage City, State

Do you have children living in your household?

Children in Household

Child 1

Child 1 - Relationship to Head of Household (Select one of the available choices or enter a different value.) Child 1 - Relationship to Head of Household Click this to indicate that you will select an existing value. Tab to next input." Child 1 - Relationship to Head of Household Child 1 - Relationship to Head of Household Click this to indicate that you will enter a new value. Tab to next input." Child 1 - Relationship to Head of Household Provide your answer here

Child 1 - Title

Child 1 - First Name

Child 1 - Middle Name

Child 1 - Last Name

Child 1 - Suffix

Child 1 - Nickname

Child 1 - Birthdate

Child 1 - Gender

Female
Male

Child 1 - Religion

Child 1 - First Language Spoken

Child 1 - Second Language Spoken

Child 1 - Baptism Date, if known

Child 1 - Baptism Church Name

Child 1 - Baptism City, State

Child 1 - First Communion Date, if known

Child 1 - First Communion Church Name

Child 1 - First Communion City, State

Child 1 - First Reconciliation Date, if known

Child 1 - First Reconciliation Church Name

Child 1 - First Reconciliation City State

Child 1 - Confirmation Date, if known

Child 1 - Confirmation Church Name

Child 1 - Confirmation City, State

Child 2

Child 2 - Relationship to Head of Household (Select one of the available choices or enter a different value.) Child 2 - Relationship to Head of Household Click this to indicate that you will select an existing value. Tab to next input." Child 2 - Relationship to Head of Household Child 2 - Relationship to Head of Household Click this to indicate that you will enter a new value. Tab to next input." Child 2 - Relationship to Head of Household Provide your answer here

Child 2 - Title

Child 2 - First Name

Child 2 - Middle Name

Child 2 - Last Name

Child 2 - Suffix

Child 2 - Nickname

Child 2 - Birthdate

Child 2 - Gender

Female
Male

Child 2 - Religion

Child 2 - First Language Spoken

Child 2 - Second Language Spoken

Child 2 - Baptism Date, if known

Child 2 - Baptism Church Name

Child 2 - Baptism City, State

Child 2 - First Eucharist Date, if known

Child 2 - First Eucharist Church Name

Child 2 -First Eucharist City, State

Child 2 - First Reconciliation Date, if known

Child 2 - First Reconciliation Church Name

Child 2 - First Reconciliation City, State

Child 2 - Confirmation Date, if known

Child 2 - Confirmation Church Name

Child 2 - Confirmation City, State

Child 3

Child 3 - Relationship to Head of Household (Select one of the available choices or enter a different value.) Child 3 - Relationship to Head of Household Click this to indicate that you will select an existing value. Tab to next input." Child 3 - Relationship to Head of Household Child 3 - Relationship to Head of Household Click this to indicate that you will enter a new value. Tab to next input." Child 3 - Relationship to Head of Household Provide your answer here

Child 3 - Title

Child 3 - First Name

Child 3 - Middle Name

Child 3 - Last Name

Child 3 - Suffix

Child 3 - Nickname

Child 3 - Birthdate

Child 3 - Gender

Female
Male

Child 3 - Religion

Child 3 - First Language Spoken

Child 3 - Second Language Spoken

Child 3 - Baptism Date, if known

Child 3 - Baptism Church Name

Child 3 - Baptism City State

Child 3 - First Eucharist Date, if known

Child 3 - First Eucharist Church Name

Child 3 - First Eucharist City State

Child 3 - First Reconciliation Date

Child 3 - First Reconciliation Church Name

Child 3 - First Reconciliation City, State

Child 3 - Confirmation Date, if known

Child 3 - Confirmation Church Name

Child 3 - Confirmation City State

Child 4

Child 4 - Relationship to Head of Household (Select one of the available choices or enter a different value.) Child 4 - Relationship to Head of Household Click this to indicate that you will select an existing value. Tab to next input." Child 4 - Relationship to Head of Household Child 4 - Relationship to Head of Household Click this to indicate that you will enter a new value. Tab to next input." Child 4 - Relationship to Head of Household Provide your answer here

Child 4 - Title

Child 4 - First Name

Child 4 - Middle Name

Child 4 - Last Name

Child 4 - Suffix

Child 4 - Nickname

Child 4 - Birthdate, if known

Child 4 - Gender

Female
Male

Child 4 - Religion

Child 4 - First Language Spoken

Child 4 - Second Language Spoken

Child 4 - Baptism Date, if known

Child 4 - Baptism Church Name

Child 4 - Baptism City, State

Child 4 - First Eucharist Date, if known

Child 4 - First Eucharist Church Name

Child 4 - First Eucharist City State

Child 4 - First Reconciliation Date, if known

Child 4 - 1st Reconciliation Church Name

Child 4 - 1st Reconciliation City, State

Child 4 - Confirmation Date, if known

Child 4 - Confirmation Church Name

Child 4 - Confirmation City, State

Additional children?
If you have more children to add, please contact Melissa Streit at mstreit@mary.org after you've submitted your form.