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Become A Parishioner

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- New Registrant REQUIRED Yes No Please fill out this field.
- Updating Contact Information REQUIRED Yes No Please fill out this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- The above information that I have provided on this Parish Registration form is true. I authorize East River Catholics/St. John Nepomucene and St. Frances Cabrini to verify all of the details I have provided on this application.
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