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Update Your Family Membership Record Today!

   
   

Does our database have YOUR family membership record correct? If you are not sure, please fill out and submit this form!

Has your phone number or email address changed? Have you recently moved? 

Maybe your grown children have moved or you have had a baby in the last year – please let us know!

This is your opportunity to update your family’s record for the 2012 St. Lucas telephone and address directory.

 
   We have again contracted with Guide Book Publishing to publish and mail directly to your home our 2012 directory at NO COST to YOU or St. Lucas.  Help us help YOU by completing the form below and clicking the submit button.  
 

     Your Name:         *D.O.B.

     *Your Cell Phone Number:  

     *Your Email Address:  

     *Your Work Phone Number:  

 

     Your Spouse's Name:        *D.O.B.

     *Spouse's Cell Phone Number:  

     *Spouse's Email Address:  

     *Spouse's Work Phone Number:  

 

     Street Address:  

    City:     State:           Zip Code:

     Home Telephone Number:  

    Listed (check one) Yes     No

   Alternate Address:

   Alternate Phone Number:

 

     Names of children who reside in your home:    *D.O.B. 

                                                                                *D.O.B. 

                                                                                *D.O.B. 

                                                                                *D.O.B. 

                                                                                *D.O.B. 

 

*For office use only - these will NOT be printed in our telephone & address directory.