Visitor Information
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We are so glad that you chose to join us. Thank you for taking the time to fill out this quick form. If you have any questions please feel free to contact our Pastor, Dr. Jason Whitehurst at (336)-581-3419.
First & Last Name(s)
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Your answer
Email
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Phone
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Address
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City
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State
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Status
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Single
Married
Age Group
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13 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60+
Please check the applicable boxes:
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First-time visit
Returning visitor
Would like to know more about this church
New to the area
Would like a visit
Would like to know more about being a Chirstian
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How did you hear about us?
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Are you currently a member of another church?
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No
Please list any questions or concerns you may have below.
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