Member Interest/Activity Survey

Today’s Date ______

Name ______D.O.B. ______

Partner/Spouse Name ______D.O.B. ______

Address: Street ______

City, State, Zip ______

Children through high school age:

Name ______Date of Birth ______

Name ______Date of Birth ______

Name ______Date of Birth ______

Name ______Date of Birth ______

Occupation ______

Primary Telephone ______Alternate Tel ______

Email ______

Emergency Contact Name ______Relationship ______

Emergency Contact Phone ______

I am a:

□Member Pledging Friend Visitor I don’t know

Please submit this form to Eileen Wiviott, Membership Director via email at or by turning the hard copy into the Church Office. Thank you!

Please indicate ways that you have or currently volunteer at church and ways you would like to volunteer in the future (check all that apply):

Past involvmt / Current involvmt / I am in-terested / Activity, Event, Group
Hospitality team – ushering, greeting
Making phone calls to guests
Rummage sale – organizing, recruiting, sorting, recycling
Lunch team –bring bagels & fruit; planning, serving, cleaning up lunches
Memorial Service hospitality – planning and serving receptions
Caring Program – sending cards, giving rides, visits to those who are ill, making meals for new parents
Pastoral Associates – providing support for those who are aging or ill
Learning Associates – coordinating adult religious education programming
Religious Education – volunteering in classrooms for children
Food & Shelter Team – soup kitchens, donations collections, work crews, volunteering at shelter
Green Sanctuary – environmental stewardship activities
Peace & Justice – advocacy and witness for peace
UCE Rainbow Alliance – GLBTQ equality
Serendipity Auction – event organization
Financial – fundraising, stewardship
New Member Committee – assisting with membership classes
Member Engagement Team
Fair Trade Fair/Fair Trade Cart/Book H

Please indicate skills and talents that you would share with the church as needed

Marketing and publicity – graphic design, writing
Music – singing or performing at Sunday service or other events
Web site – development/maintenance/design
Office support – mailings, data organization
Buildings & Grounds – carpentry, painting, plumbing, electrical
Gardening

Please indicate ways you are involved or would like to become involved

Currently Involved / Interested in involvement / Activity/Group
Covenant Groups
Men’s Group
Women’s Circle
Choir
Star Trekkers
Common Threads – knitting or crochet
Retreats – Winter Family, Fall Lake Geneva, Summer Camping
Young Adults Group – 18-35 year olds
Book Groups – Intergenerational, Fiction, Non-Fiction
Greenwood Group – Investing
Crackerbarrel Discussion Group
Neighborhood Groups
Friendship Dinners/Family Friendship Dinner
Retired Ladies Group