Welcome to Our Lady of the Miraculous Medal! Visit our web site at
 www.beachcatholic.com/OLMM/ for more information about our parish.

Click Submit Form to send this information to Our Lady Of The Miraculous Medal Church.

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*Registration Option Register a New Family Update an Existing Family *ID/Env:  

Head of Household
Title *First Name *Last Name Suffix
Relationship   Middle Name   Nickname Maiden Name
Ethnicity   Birth Date *Gender Female   Male
  Language Marital Status
Note: If you would like to receive a text message when your parish sends a quick communication,
select your provider from the Description drop-down list. Standard text messaging rates apply.
  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
Remarks    

Spouse
Title   First Name   Last Name Suffix
Relationship   Middle Name   Nickname Maiden Name
Ethnicity   Birth Date   Gender Female   Male
  Language Marital Status
Note: If you would like to receive a text message when your parish sends a quick communication,
select your provider from the Description drop-down list. Standard text messaging rates apply.
  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
Remarks    

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

Family Mailing Address
  Line 1
  Line 2
  City
  State
  ZIP

Family Alternate Address
  Line 1
  Line 2
  City
  State
  ZIP

Family Phone Numbers
Note: If you would like to receive a text message when your parish sends a quick communication,
select your provider from the Description drop-down list. Standard text messaging rates apply.
*Primary ( ) - Unlisted
  Other ( ) - Unlisted
Email
*Email   Unlisted
Send Email Instead of Mail When Possible
Family Remarks
  Remarks

Member 1   Type  
Title   First Name   Last Name Suffix
Relationship   Middle Name   Nickname Maiden Name
Ethnicity   Birth Date   Gender Female   Male
Grade/Degree   Language Marital Status
Note: If you would like to receive a text message when your parish sends a quick communication,
select your provider from the Description drop-down list. Standard text messaging rates apply.
  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
Remarks    


Click Submit Form to send this information to Our Lady Of The Miraculous Medal Church.

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