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(219)769-1755

office@qofm.org

8303 Taft Street, Merrillville, Indiana 46410, United States

Our Lady Queen of Martyrs Registration Form

Welcome to Our Lady Queen of Martyrs. Visit our web site at www.qofm.org for more information or
contact the parish office at 219-769-1755.

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Click Submit Form to send this information to Our Lady Queen of Martyrs.

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* Family Option	New Family Information	Update Existing Family Information ID/Env:
	Call Our Lady Queen of Martyrs at (219) 769-1755, if you do not know your ID Number or Envelope Number.

Head of Household
Title		Suffix
* First Name		* Last Name
Middle Name		Nickname
* Relationship		Maiden Name
Ethnicity		* Birth Date
* Gender		Grade/Degree
Language		* Marital Status
Phone 1		()- Unlisted
Phone 2		()- Unlisted
Email 1		Unlisted
		Send Email Instead of Mail When Possible
Email 2		Unlisted
		Send Email Instead of Mail When Possible
Sacraments
Baptism		Date	Place
Reconciliation		Date	Place
First Communion		Date	Place
Confirmation		Date	Place
Marriage		Date	Place

Spouse
Title		Suffix
First Name		Last Name
Middle Name		Nickname
Relationship		Maiden Name
Ethnicity		Birth Date
Gender		Grade/Degree
Language		Marital Status
Phone 1		()- Unlisted
Phone 2		()- Unlisted
Email 1		Unlisted
		Send Email Instead of Mail When Possible
Email 2		Unlisted
		Send Email Instead of Mail When Possible
Sacraments
Baptism		Date	Place
Reconciliation		Date	Place
First Communion		Date	Place
Confirmation		Date	Place
Marriage		Date	Place

Family Street Address
* Line 1
Line 2
* City
* State
* ZIP

Family Phone Numbers
* Primary		()- Unlisted
Other		()- Unlisted
Email
* Email		Unlisted
		Send Email Instead of Mail When Possible

Member 1		Type
Title		Suffix
First Name		Last Name
Middle Name		Nickname
Relationship		Maiden Name
Ethnicity		Birth Date
Gender		Grade/Degree
Language		Marital Status
Phone 1		()- Unlisted
Phone 2		()- Unlisted
Email 1		Unlisted
		Send Email Instead of Mail When Possible
Email 2		Unlisted
		Send Email Instead of Mail When Possible
Sacraments
Baptism		Date	Place
Reconciliation		Date	Place
First Communion		Date	Place
Confirmation		Date	Place
Marriage		Date	Place