digital connection Card

Name: *

First Name

Last Name

Visitor: *

1st Time Visitor

2nd Time Visitor

Regular Attendee (Update Info)

Home Phone:

(###)

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Mobile Phone:

(###)

###

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Date of Birth:

MM

DD

YYYY

Spouse Date of Birth:

MM

DD

YYYY

Spouse Cell:

(###)

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender:

Male

Female

Date of Birth:

MM

DD

YYYY

Gender:

Male

Female

Date of Birth:

MM

DD

YYYY

Gender:

Male

Female

Date of Birth:

MM

DD

YYYY

Would you like more information about any of the following ?

Beginning a Relationship with Jesus

Baptism

Family Dedication

Partnership Class

Youth Ministry

Children's Ministry

Remedy

Serving Opportunities

Prayer Team