Name *

First Name

Last Name

Name *

First Name

Last Name

Need Offering Envelopes

Please mark if you need offering envelopes

Yes

Would Like to Meet with the Pastor

Please mark if you'd like to schedule a meeting with the Pastor

Yes

Name *

First Name

Last Name

Phone Number

(###)

###

####

Second Phone Number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Use Previous Year's Photo?

Yes

No

Ok to Publish in Directory?

Yes

No