Following Jesus—Some Information About Yourself

Welcome to the family of God! We are overjoyed that you have made the life-changing decision to accept Jesus' free offer of salvation and give your life to Him in return! Please fill out the following form so we can pray for you and send you materials to help you in your new relationship with Christ.
First Name:
Last Name:
Address:

City, Zip:	,
State:
Country:
Phone:
Email:
Do you currently attend a church?	Yes No
If yes, what is the name and location of the church?
Please tell us some about your salvation experience. (ie: Are you a new believer or is this a rededication).