Info Request
Please take a moment and fill out the following as we are updating the church office records and would like to have current contact information for all members and attendees of Bethel Pentecostal Church. All the information does not need to be filled in below, only that with which you are comfortable sharing. Thank you!
Email address *
Last Name
First Name
Prefix
Clear selection
Gender
Clear selection
Date of Birth
MM
/
DD
/
YYYY
Marital Status
Clear selection
Address (please include your postal code)
Cell Number *
Home Phone
How long have you been attending Bethel
Name of Spouse (if applicable)
Birthdate of Spouse
MM
/
DD
/
YYYY
Email of Spouse
Anniversary
MM
/
DD
/
YYYY
Name of Children and date of birth (if applicable)
Email of children if applicable
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This form was created inside of Bethel Pentecostal Church.