Life Bible-Presbyterian Church
9A Gilstead Road, Singapore 309063 Mailing address: 10 Gilstead Road, Singapore 309064 Tel: 65-65949399; Fax: 65-62506955
Full Name: (required)
Title: Please choose Mr Miss Mdm Dr Dn Eld Rev
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Date of Birth (day/month/year): Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec /
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Address: To be published in church directory: Yes No
Tel (H): To be published in church directory: Yes No
Tel (O): To be published in church directory: Yes No
Pager: To be published in church directory: Yes No
Mobile: To be published in church directory: Yes No
Email: To be published in church directory: Yes No
Marital Status: Please choose Single Married Widowed Divorced
Date of Marriage (day/month/year): Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec /
Spouse's Full Name:
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