Fellowship Orientation Registration

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email
Church Membership (current or last known)
How long have you lived in Chicago?
Please list the names, relationships and ages of family members who will be received into fellowship with you.
Please list the names, relationships and ages of family members who will NOT be received into fellowship with you.

St. James Lutheran Church

2050 N. Fremont St., Chicago, IL, 60614

Phone: 773-549-1615 I Fax: 773-326-3645

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