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Connection Card
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Email
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Your email
Date
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DD
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YYYY
First Name
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Your answer
Last Name
*
Your answer
Address
*
Your answer
City
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Your answer
State
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Your answer
Zip Code
*
Your answer
Phone #
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Your answer
Email
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Your answer
Birth date
MM
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DD
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YYYY
How did you hear about us?
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Other:
How Can We Help?
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Beginning a relationship with Jesus
I would Like a pastor to contact me
Information on baptism
Information on church membership
Other:
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Today, do I choose Jesus as:
*
Lord of my private thoughts, words, and life
Lord of my family life
Lord of my work life
Lord of my financial life
Other:
Is there one person that you'd commit to praying for their salvation each day for a month?
Who is your "one"?
Your answer
Confidential prayer request
Your answer
Public prayer request
Your answer
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