Connection Card

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Connection Card

First Name *

Last Name *

Email *

Mobile Phone

Street

City

State

Postal Code

Marital Status

My Age

Under 18

18-29

30s

40s

50s

60s +

Clear selection

I am a... *

1st Time Guest

Returning Guest

Regular Attender

Member

If you are a 1st or 2nd time guest, how did you hear about ERBC?

Online

Social Media

Driving By

Invited By Someone

Clear selection

If you were invited by someone, please indicate who below:

My Next Step is to...

Trust Jesus and begin following Him as my Lord and Savior for the first time today

Clear selection

Memorize Romans 12:18

Clear selection

Ask God to help me to forgive those who have hurt me in the past

Clear selection

Pursue peace where peace is possible in a relationship that has been strained or broken

Clear selection

I'd like to learn more about:

Taking the step of Baptism

Serving on the Weekend Welcome Team

Serving on the Hospitality Team

Serving on the Children’s Ministry Team

Question

Faith & Film Movie Night: I Can Only Imagine 2 (8.5)

Question

Mom’s In Prayer (8.6)

Question

Street Kitchen Homeless Feeding Program (8.15)

Question

ERBC Beach Day (9.5)

Prayer Request

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms