Community Group Member Form
Please fill out the form below completely.
Name
Your answer
Address
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City
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State
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Zip code
Your answer
Cell phone *
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Email address *
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Home phone
Your answer
Date of birth
MM
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DD
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YYYY
Gender
Marital status
If married, name of spouse
Your answer
Names and age of children
Enter the name and age of each child, one per line
Your answer
Occupation
Your answer
How many years have you attended Upper Room?
Your answer
Which weekly services do you attend?
When were you "born-again"?
MM
/
DD
/
YYYY
Have you received the Holy Spirit, with the evidence of speaking in other tongues?
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