First Name Last Name Title Street Address Address (cont.) City State/Province Zip/Postal Code Work Phone Home Phone FAX E-mail Check which day(s) you prefer to help: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Check which day(s) you CANNOT help: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Your Age Group: 18-24 25-32 33-41 42-55 55 Your Marital Status: Single Married Blended Family Other Age(s) of Children Infants Toddlers/Preschoolers Elementary Adolescents Adults Check which ministry you would like to help in ? Women of Purpose Men's Ministry Prison Ministry EXP Life Teen's Young Single Adults Kidz House Nursery/Toddlers Sunday School Dept. Deacons Ushers Single Parents Married Couples New Convert's Video Audio Comments or Questions? How many years have you been attending our Church? Security code:   * Do not enter anything in this field:

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