Become a Member

Where do you wish to register? REQUIRED St. Bernard (Middleton) St. Francis Xavier (Cross Plains) St. Martin of Tours (Martinsville) St. Mary (Pine Bluff) St. Peter (Ashton) All of Them (I wish to join the Pastorate) Please fill out this field.

Family (Last) Name REQUIRED Please fill out this field. Please enter valid data.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Full Mailing Address (if different from above) Please enter valid data.

Primary Email REQUIRED Please fill out this field. Please enter an email address.

Primary Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Marital Status REQUIRED Single Married (in the Church) Civilly Married (but not married in the Church) Divorced Separated Widowed Please fill out this field.

Would you like to receive The Catholic Herald (The Diocese of Madison newspaper)? REQUIRED Yes No Please fill out this field.

Husband (or Male Head) Full Name Please enter valid data.

Husband (or Male Head) Date of Birth Please enter valid data.

Husband (or Male Head) Religion Please enter valid data.

Husband (or Male Head) Occupation Please enter valid data.

Husband (or Male Head) Cell Phone Number Please enter a phone number.

Huband (or Male Head) Email Please enter an email address.

Husband (or Male Head) Baptized? Yes No Not Sure

Husband (or Male Head) Date of Baptism Please enter valid data.

Husband (or Male Head) Location of Baptism Please enter valid data.

Husband (or Male Head) Confirmed? Yes No Not Sure

Husband (or Male Head) Date of Confirmation Please enter valid data.

Husband (or Male Head) Location of Confirmation Please enter valid data.

Husband (or Male Head) Married? Yes No

Husband (or Male Head) Date of Marriage Please enter valid data.

Husband (or Male Head) Location of Marriage Please enter valid data.

Husband (or Male Head) - Please list any previous marriages, divorces, and/or annulments Please enter valid data.

Wife (or Female Head) Full Name Please enter valid data.

Wife (or Female Head) Date of Birth Please enter valid data.

Wife (or Female Head) Religion Please enter valid data.

Wife (or Female Head) Occupation Please enter valid data.

Wife (or Female Head) Cell Phone Number Please enter a phone number.

Wife (or Female Head) Email Please enter an email address.

Wife (or Female Head) Baptized? Yes No Not Sure

Wife (or Female Head) Date of Baptism Please enter valid data.

Wife (or Female Head) Location of Baptism Please enter valid data.

Wife (or Female Head) Confirmed? Yes No Not Sure

Wife (or Female Head) Date of Confirmation Please enter valid data.

Wife (or Female Head) Location of Confirmation Please enter valid data.

Wife (or Female Head) Married? Yes No

Wife (or Female Head) Date of Marriage Please enter valid data.

Wife (or Female Head) Location of Marriage Please enter valid data.

Wife (or Female Head) - Please list any previous marriages, divorces, and/or annulments Please enter valid data.

Child #1 - Please provide 1) Full Name; 2) Date of Birth; 3) Location of Birth; 4) Biological Sex; 5) Current School & Grade; 6) Religion; 7) Baptism Date and Location

Child #2 - Please provide 1) Full Name; 2) Date of Birth; 3) Location of Birth; 4) Biological Sex; 5) Current School & Grade; 6) Religion; 7) Baptism Date and Location

Child #3 - Please provide 1) Full Name; 2) Date of Birth; 3) Location of Birth; 4) Biological Sex; 5) Current School & Grade; 6) Religion; 7) Baptism Date and Location

Child #4 - Please provide 1) Full Name; 2) Date of Birth; 3) Location of Birth; 4) Biological Sex; 5) Current School & Grade; 6) Religion; 7) Baptism Date and Location

Child #5 - Please provide 1) Full Name; 2) Date of Birth; 3) Location of Birth; 4) Biological Sex; 5) Current School & Grade; 6) Religion; 7) Baptism Date and Location

Child #6 - Please provide 1) Full Name; 2) Date of Birth; 3) Location of Birth; 4) Biological Sex; 5) Current School & Grade; 6) Religion; 7) Baptism Date and Location

Child #7 - Please provide 1) Full Name; 2) Date of Birth; 3) Location of Birth; 4) Biological Sex; 5) Current School & Grade; 6) Religion; 7) Baptism Date and Location

Child #8 - Please provide 1) Full Name; 2) Date of Birth; 3) Location of Birth; 4) Biological Sex; 5) Current School & Grade; 6) Religion; 7) Baptism Date and Location

Child #9 - Please provide 1) Full Name; 2) Date of Birth; 3) Location of Birth; 4) Biological Sex; 5) Current School & Grade; 6) Religion; 7) Baptism Date and Location

Child #10 - Please provide 1) Full Name; 2) Date of Birth; 3) Location of Birth; 4) Biological Sex; 5) Current School & Grade; 6) Religion; 7) Baptism Date and Location

Do you have any questions? Is there any specific information that you are looking for? REQUIRED Please fill out this field.

Become a Registered Member

Online Registration