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30-30-30

Christ Church Laredo - Selfie Directory Form

Dear Parishioners - Please enter the info. If you prefer to do so over the phone or by some other means call the parish office. 956-723-5714

I understand that I am giving Christ Church Episcopal in Laredo, Texas permission to publish some or all of this information in an online and paper format. Checking this box is my authorization of the same. *

I authorize the use of this data for the online and paper Parish Directories

Please add head or heads of household names first

* Indicates required field

Head of household *

First

Last

Middle name or initial *

Date of Birth *

Additonal Head of household *

First

Last

Middle name or initial *

Date of Birth *

Mobil Phone Number *

Home Phone Number *

Work Phone Number *

Include the following in directory *

All phone numbers & email Only mobil Only home Only work Only email Other - see below

Other preferred contact methods - describe *

Preferred Email *

Address to use in directory *

Line 1

Line 2

City

State

Zip Code

Country

If you do not plan to sign up for one of our photo shoots, but want to include a picture in the directory, please upload a picture of youself and/or your household you wish us to include. If file does not upload, email or text us the picture and let us know who it is from and we will insert it. *

Max file size: 20MB

Mobil Phone Number *

Home Phone Number *

Work Phone Number *

Include the following in directory *

All phone numbers & email Only mobil Only home Only work Only email Other - see below

Other preferred contact method - describe *

Preferred Email *

Please list other household members you wish included in the directory. Only list their phone number if you wish it listed in the directory.

Name *

First

Last

Date of Birth *

Phone Number *

Name *

First

Last

Date of Birth *

Phone Number *

List any additional Names, Birthdays, and Numbers below. *

Submit