CONNECTION CARD
Let us know about you!
TODAY'S DATE
First Name
Middle Name
Last Name
Mailing Address
Mailing City
Mailing State
Mailing Zip Code
Email Address
Date of Birth
Phone Number
Marital Status
Single
Engaged
Married
Partner
Widowed
Divorced
Separated
Anniversary
FIRST TIME GUEST
YES
NO
I HAVE BEEN HERE BEFORE
IS THIS A CHANGE OF ADDRESS?
YES
NO
I AM INTEREST IN RECEIVING THE NEWSLETTER BY EMAIL
YES
NO
TODAY I SAID YES TO CHRIST
YES TO CHRIST
I WOULD LIKE MORE INFORMATION ON BAPTISM
I CONSIDER CHADRON CHRISTIAN CHURCH AS MY HOME CHURCH AND I WISH TO BE A PART OF THIS FAMILY
YES
NO
MAYBE
BABY DEDICATION
I WOULD LIKE MORE INFORMATION
Remove
Add Another Person
Submit