Member Contact Information Update

* Indicates required field.

In order to keep the church records current, please complete the following information whenever you have any change to your contact information. Please complete all information even though you may have only changed one item. If you have any questions, please call 714-897-4026 or email westminstergoodsam@yahoo.com. Thank you so much!

Contact Update as of...

mm/dd/yyyy

Name*

First

Last

Birthdate*

mm/dd/yyyy

Address

Address 1

Address 2

City

State

Postal code

Country

Home Phone numberinclude area code

Cell phone number*include area code

Emailso we can add you to the WGS distribution list

Additional family members...please include all family members that live at the location given above.

Name

First

Last

Name

First

Last

Name

First

Last

Name

First

Last

Name

First

Last

Name

First

Last

Notes...please include any additional information here...

Date

yyyy/mm/dd

Westminster Good Samaritan

Member Contact Information Update