Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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Date of Birth

MM

DD

YYYY

Anniversary Date (if applicable)

MM

DD

YYYY

Would you like to include your contact information in our church directory? *

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Our church is run by volunteers. If you are interested in serving, please indicate below.

Worship Team

Tech Team

Events Team

Children's Ministry

Email Prayer Team

Usher

Maintenance

Greeter

Other As Needed