CBC Contact Form

We genuinely appreciate your attending or visiting CBC. We want a record of your visit and want to pray for you and your family. Please fill out a record for each family member individually.

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Nick Name (Optional)
Preffered name you want to be called by.
First Name *
Please use the name appropriate for birth certificates, marriage certificates, baptism certificates, etc.
Last Name *
Gender *
Spouse Name
This is not in place of your spouse's record. Please fill out individually.
Date of Birth
MM
/
DD
/
YYYY
Member Status *
Street Address
City
State
Zip Code
Phone Nmber
Email
Submit
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