Church of The Assumption

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New Parishioners - Nuevos Parroquianos

- New Parishioners

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- Name - Nombre REQUIRED Please fill out this field. Please enter valid data.
- Last Name - Apellido REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth - Fecha de Nacimiento. MM/DD/YYYY REQUIRED Please fill out this field. Please enter a date.
- Religion - Religión REQUIRED Please fill out this field. Please enter valid data.
- Mailing Address - Dirección REQUIRED Please fill out this field. Please enter valid data.
- City (Ciudad), State (Estado) & Zip Code (Apartado Postal) REQUIRED Please fill out this field. Please enter valid data.
- Phone Number - Telefono REQUIRED Please fill out this field. Please enter a phone number.
- Email - Correo Electrónico Please enter an email address.
- Preferred Language - Idioma Preferido REQUIRED Please fill out this field.
- I give my permission to a staff member of Church of the Assumption to contact me using the information I have provided above.
  
  Autorizo a la Iglesia de la Asunción a contactarme si necesitan mas información
  I Agree - Aceptar Please select this field.
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- New Parishioner
- Nuevos Parroquianos