Head of Household Name #1:

Birthday:

Email Address:

Cell Phone #:

Text? Text? Yes No

Head of Household Name #2:

Birthday:

Email Address:

Cell Phone #:

Text? Text? Yes No

Wedding Anniversary:

Home Address:

Winter Address (if applicable):

What months are you at the above winter address?

Landline Phone Number (if applicable):

Additional Household Member(s): (Name, Birthday, Email Address, Cell #)

Permission to be included in Online Church Directory Permission to be included in Online Church Directory Yes, include me/us in password-protected online directory available only to BBC families (members & regular attenders) No, do not include me/us in the password-protected online church directory.

Specify information that is for Church Office use only and to be excluded from the paper directory and/or online directory