Bethlehem Church Connection Card
Please share as much information as you feel comfortable sharing.

Only a few items are required.
First Name *
Last Name *
Email *
If you do not have an email address, please write "none."
Phone
Please use the 555-555-5555 format.
Street / Mailing Address
City
State
ZIP *
Are you a... *
How are you participating in worship? *
How many people (including you) are watching / listening with you? *
How did you find out about Bethlehem's online worship or radio broadcast?
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Prayer Request
These are prayed for each week by our staff.
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