Connection Card
Name:
Your answer
Address:
Your answer
City, State, Zip:
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Cell Phone:
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Email:
Your answer
Date of Birth:
MM
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DD
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YYYY
Are you a:
People in your household:
Husband/Wife
Your answer
Date of Birth
MM
/
DD
/
YYYY
Child 1 (if applicable)
Your answer
Date of Birth
MM
/
DD
/
YYYY
Child 2 (if applicable)
Your answer
Date of Birth
MM
/
DD
/
YYYY
Do you attend Church regularly
If so, Where?
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I am a guest of:
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My decision today :
I would like to serve in the following area(s):
Prayer Needs - (List New or Updated request)
Your answer
Do you want your prayer request kept Confidential among the council and staff?
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