Visitor Information

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Visitor Information

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) *

Email *

Phone *

Address *

City *

State *

Status *

Single

Married

Age Group *

13 - 19

20 - 29

30 - 39

40 - 49

50 - 59

60+

Please check the applicable boxes: *

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

Required

How did you hear about us? *

Are you currently a member of another church? *

Yes

Please list any questions or concerns you may have below.

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