Membership Application - St. Peter's Episcopal Church

Church

Address

Address Line 1

Address Line 2

City

State

Zip Code

St. Peters Episcopal Church
46 S. Laurel Street
Hazleton, PA. 18201

Full Name

Date of Confirmation (Approximate if necessary)

Date of Transfer to church now leaving

Full name at Confirmation, if different than at present

Name of other family members seeking membership or transfer

Please complete another application if necessary.