St. Raphael Parish

                  346 E. Mt. Pleasant Avenue
                  Livingston, NJ  07039-1502
             Phone: 973/992-9490  Fax: 973/740-0236
     E-mail: STRaphaelRCC@comcast.net  Website: www.StRaphaels.net


             NEW PARISHIONERS' REGISTRATION FORM

The pastoral staff and people of St. Raphael Parish welcome you 
as new members of our community.  Completing this form is all 
that is needed for you and the members of your family to be 
registered as members of the parish.  We thank you for wanting 
to be a part of our faith community.

Date: ______________

I/We would like my/our name(s) to appear on mailings as follows:

        _________________________________________________________

Address _________________________________________________________

City, State, Zip code ___________________________________________

Telephone Number __________________________  (unlisted?  ____ )

E-mail address __________________________________________________

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HOUSEHOLD MEMBERS:


(Husband/Father): _______________________________________________
 	          First Name     MI        Last Name

  (Title: Mr/Dr, etc: ______ )          Date of Birth____________  


(Wife/Mother):    _______________________________________________
	             First Name     MI        Maiden Name

  (Title: Miss/Mrs/Dr, etc: ______ )    Date of Birth____________  


Full Name(s) of dependent child(ren) living in your home:

______________________________________  Date of Birth____________

______________________________________  Date of Birth____________

______________________________________  Date of Birth____________

______________________________________  Date of Birth____________

Other adults living in your home:

________________________________________Date of Birth____________  

________________________________________Date of Birth____________