Blessed Sacrament Church

NAME CHANGE

AND/OR

CHANGE OF ADDRESS

Please type or print clearly.

TODAY’S DATE: __________________

Old Name (as you are presently registered):
New Name (as you wish to be registered):
Old Address:
	Street Number	Street Name	Apt . #
	City	State	Zip
	Telephone Number
New Address:
	Street Number	Street Name	Apt. #
	City	State	Zip
	Telephone Number
Do you wish to remain in Blessed Sacrament Parish as an active member (“active” means, contributing to the life of the Parish financially and/or by participating in one or more of the Parish’s ministries)?
Comments: