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    Please note that this information is for internal Northcity use only and will not be shared with any other parties. Any information that you would like published in the Member Contacts Directory must be specified by you, and you can only receive a copy of the Directory (published annually) if you are a prayed in member of Northcity AND have agreed for at least some of your details to be included in it.

    If you have any questions, please don't hesitate to get in touch. Thanks!

    Household Name(required) How would you like to be collectively known (e.g. The Smith Family, Liz & Phil Windsor)?

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    Postcode

    Country

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    What information (if any) would you like to be published in our Members Contacts Directory?
    AddressHome Phone

    Are You currently part of a Connect Group/s?
    YesNo

    If you answered "Yes", which one/s?

    If you answered No would you like to find out more?
    YesNo

    Do you want to be allocated a Tithe Number?
    YesI have one alreadyNot at this time

    First Name 1 (required)

    Surname 1 (required)

    Mobile Phone 1

    Email 1

    Would you like our fortnightly newsletter sent to this email address?
    YesNo

    What information (if any) would you like to be published in our Members Contacts Directory?
    Name 1Mobile 1Email 1

    First Name 2

    Surname 2

    Mobile Phone 2

    Email 2

    Would you like our fortnightly newsletter sent to this email address?
    YesNo

    Birth Date (only required for children and dependent minors)

    What information (if any) would you like to be published in our Members Contacts Directory?
    Name 2Mobile 2Email 2

    First Name 3

    Surname 3

    Mobile Phone 3

    Email 3

    Would you like our fortnightly newsletter sent to this email address?
    YesNo

    Birth Date (only required for children and dependent minors)

    What information (if any) would you like to be published in our Members Contacts Directory?
    Name 3Mobile 3Email 3

    First Name 4

    Surname 4

    Mobile Phone 4

    Email 4

    Would you like our fortnightly newsletter sent to this email address?
    YesNo

    Birth Date (only required for children and dependent minors)

    What information (if any) would you like to be published in our Members Contacts Directory?
    Name 4Mobile 4Email 4

    First Name 5

    Surname 5

    Mobile Phone 5

    Email 5

    Would you like our fortnightly newsletter sent to this email address?
    YesNo

    Birth Date (only required for children and dependent minors)

    What information (if any) would you like to be published in our Members Contacts Directory?
    Name 5Mobile 5Email 5

    First Name 6

    Surname 6

    Mobile Phone 6

    Email 6 6

    Would you like our fortnightly newsletter sent to this email address?
    YesNo

    Birth Date (only required for children and dependent minors)

    Publish in Members Contacts Directory?
    Name 6Mobile 6Email 6

    First Name 7

    Surname 7

    Mobile Phone 7

    Email 7

    Would you like our fortnightly newsletter sent to this email address?
    YesNo

    Birth Date (only required for children and dependent minors)

    What information (if any) would you like to be published in our Members Contacts Directory?
    Name 7Mobile 7Email 7