Central Assembly Communication

Central Assembly Communication Guest? Visitor? Information Updates? Prayer Requests? Did you make a decision today? Just use this easy form to get the information to us! * Last Name * First Name Last Name (Spouse) First Name (Spouse) Today's Date   [dd-MMM-yyyy] Primary E-mail Secondary E-mail Home Phone Mobile Phone 1 Mobile Phone 2 Address City State Zip What brought you to Central Assembly today? Age Group or Current School Grade -Select- 18-23 24-30 31-35 36-40 41-45 46-50 51-60 61-70 71+ K 1 2 3 4 5 6 7 8 9 10 11 12 Marriage Status Single Married Name and Birth Dates of Children (Example: Jane Doe, 04/06/2002 Child 1 Child 2 Child 3 Child 4 I am interested in: (check all that apply) Children Junior High Senior High Single Adults College Age (18-23) Men Women Seniors Single Parents Bible Study Groups Music Couples Recreation/Sports My Decision Today I'm committing my life to Jesus Christ I want to be baptized I'm renewing my commitment to Jesus Christ I'm willing to help where needed I'd Like Information On: How to commit my life to Jesus Christ How to grow in my relationship with Jesus Christ How to join this church family How to get involved in children's ministry Prayer Request

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