Revive Connection Form

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Fill out this form if you would like to take a next step in your faith! Someone from our connection team will reach out to you! This is also a place to submit prayer request, if something is on your heart feel free to skip to the bottom and submit those, we would love to be praying for you!

Name *

Phone Number

Gender

Male

Female

Prefer Not to Say

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Year

First

Second

Third

Fourth

Fifth

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Would you like to follow up with someone about your experience with Revive?

Yes

Unsure

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Would you like to follow up with someone about your relationship with Jesus?

Yes

Unsure

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Would you like to follow up with someone about finding a local church?

Yes

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Would you like to follow up with someone for any other reason? If so, please write why.

Is there any way we could be praying for you?

Where do you consider your relationship with Jesus to be?

Unsure

Just starting out / exploring my faith

I am a Christian, but I am not currently pursuing my faith

I'm pursuing an active relationship with Jesus

Other:

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