On-Line Sign-Up'03

STLM CFM REGISTRATION
We want you to join CFM - We'll try to make it Fast & Easy.

Send an email to

Include all your pertinent data.
IF your not sure what to do give us a call.
Mary & John Poprac 618-9827
Denise & Ron Geltz 375-7931

CALL US if you have any questions

Mail your $45 check (made out to "STLM CFM") to:
    CFM c/o Denise Geltz.
    22317 Ellinwood Dr.
    Torrance, CA 90505

Membership benefits include:

Participation in the total CFM experience

A one year subscription to the CFM Newsletter, ACT

The current program book
Service and assistance from Federation, Area and National Leaders

All the fun stuff and good work CFM does here at STLM!

CFM MEMBERSHIP FORM

Today's Date* :	please use "mm/dd/yy" format example: 09/07/05 (September 7, 2005)

His First Name* :
His Last Name* :

Her First Name* :
Her Last Name* :

Address Line 1* :	(Include Unit or Apt #)
City* :	If "other" please fill in 2nd box:
State* :
Zip Code* :	If "other" please fill in 2nd box:

Home Phone* :	- - 310 - 555 - 1212 style Indicate Type: his/her, wk, cell, pager, etc.
Other Phone :	- - 310 - 555 - 1212 style Indicate Type: his/her, wk, cell, pager, etc.
Other Phone :	- - 310 - 555 - 1212 style Indicate Type: his/her, wk, cell, pager, etc.
Primary Email* :	Indicate Type: his/her, wk, hm, etc.
Other Email :	Indicate Type: his/her, wk, hm, etc.
Year First Joined CFM* :
Member Last Year?* :	yes no
Dues* :	other amount:
Your Check Number :	(if you have it now)

Parish* :	if "other" please fill in 2nd box:
Parish City* :	if "other" please fill in 2nd box:

His Religion* :
His Occupation* :

Her Religion* :
Her Occupation* :

Marital Status/Year Married* :

Child 1 Age :	Name: B-day:mm/DD/yy
Child 2 Age :	Name: B-day:mm/DD/yy
Child 3 Age :	Name: B-day:mm/DD/yy
Child 4 Age :	Name: B-day:mm/DD/yy
Child 5 Age :	Name: B-day:mm/DD/yy

Talents :	- Enter talents to share with CFM: (Remove/Replace all this text)
Other Activities:	- Enter other ministries, church activites or outreach activities you are presently invoved with (if any): (Remove/Replace all this text)
WHY CFM?:	- We're glad you are joining CFM. What do you want to get out of your experience in CFM? (Remove/Replace all this text)
Anything Else:	- List anything else you would like to share with us. (Remove/Replace all this text)
Other Comments :	- Other comments: (Remove/Replace all this text)

* = Required Entry

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YOU MUST Click 'Submit the Form' (above) to have the information processed

After you have submitted your completed form, you should see a "THANK YOU" page.
IF NOT, CALL US ! ... YOUR REGISTRATION MAY NOT BE PROCESSED.
After you see the "Thank You" Page, continue to review the material here on our STLM CFM website.

This page was last updated on 06/11/05.