Parish Registration Form

Contact Us

Please complete and submit this form to register to become a member of St Mary of the Visitation Church, or to update information on your current church membership record. Complete one form for each adult member of the household.

Parish Registration Form

Member Status:

New Member - for each adult in household

Current Member - to enter updates to current information

Financial Giving Option:

I'm interested in Electronic Giving

I would like to receive envelopes

Undecided, send more information

Name: First, Middle, Last (Maiden)

Nickname:

Gender:

Birthdate: (mm/dd/yyyy)

Religious Affiliation:

Home Address: (number & street)

City, State, Zip Code

Home Phone:

Cell Phone:

Email Address:

Occupation:

Employer:

Baptized

First Eucharist

Confirnmation

Marital Status

Spouse Name: (First, Last)

Wedding Date: (mm/dd/yyyy)

Children Information:

We welcome you to be part of our parish family.

CONTACT OUR PARISH OFFICE

Office Location: 222 N. Ward St. Ottumwa IA

Office Phone: 641-682-4559 (10AM - 4PM Tues - Fri)

Office Email: ottstmary@diodav.orgNew Paragraph

JOIN OUR FAMILY

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