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First Name

Last Name

Birthdate

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Marital Status

Spouse First Name

Spouse Last Name

Spouse Birthdate

Your Kids Names & Birthdays (don't worry - this just for our records)

I WOULD LIKE

a church mailbox

church communication by email (newsletter + prayer requests)

COMMUNICATION WITH CHURCH LEADERSHIP (Comments, suggestions and questions)

PRAISES + PRAYER REQUESTS