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Please be sure to complete information on each person living in the household even if they are not joining DRLC. Each adult person (14 and over) who is joining DRLC should read and sign the Statement of Faith and Decision, Petition and Promise on the last page of this application. Print out this form (3 pages) to complete.


HOUSEHOLD INFORMATION:
Last Name:
 
Date of Application:
Primary Address:
   Street:
   City:
 
State & Zip:
Secondary Address: (Complete if you live at this address for more than 8 weeks of the year)
   Street:
   City:
 
State & Zip:
   Dates of residence at this address: _____________________ to ___________________________
Primary Phone :    
Cell Phone: (        ) ________________________ for
Cell Phone: (        ) ________________________ for
Home Email Address:
May Staff Members Contact you at your Home Email Address ?     ♦ YES    ♦ NO
HEAD OF HOUSEHOLD INFORMATION:
Title:   ♦ Dr.     ♦ Miss    ♦ Mr.     ♦ Mrs.    ♦ Rev.     ♦ Other: _________________________________
First Name:
  Middle Initial
Last Name:
  Nickname:
Maiden Name:
     
Baptized: ♦ YES    ♦ NO   Baptism Date:
Confirmed: ♦ YES    ♦ NO   Confirmation Date:
Date of Birth:
  ♦ MALE     ♦ FEMALE
Marital Status: ♦ Married     ♦ Divorced    ♦ Separated     ♦ Single     ♦ Widowed
Wedding Date:
  Spouse's Name:
# of Children:
  # of Children at home:
Employer:
Occupation Title:
Work Phone:
  May we contact you at this number?     ♦ YES    ♦ NO
Is this person joining DLC?    ♦ YES    ♦ NO      
Current Church Membership at: (Name, City, State)  
Church Background:  
Father's First Name:
  Father's Last Name:
Mother's First Name:
  Mother's Last Name:
Do you or any member of your household currently hold insurance or a financial product from
Thrivent Financial for Lutherans (formerly AAL and Lutheran Brotherhood)?    ♦ YES    ♦ NO
       
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