Please submit this Change of Status form to the Church office by
e-mail, regular mail, fax to 931-552-0331, in person at the office, or by way of the collection basket at all Masses.

The form may be downloaded by clicking here or you may use this convenient online form to submit your changes.

Immaculate Conception Church  Change of Status Form
Please indicate in the space below any changes in family members, address, phone number or marital status.
Registered Name:
Phone Number:

Fr. David Gaffny, Pastor

709 Franklin Street • Clarksville , Tennessee 37040 • (931) 645-6275