Worship Follow-Up & Requests
Today's Date
-
Month
-
Day
Year
Date
Date Joined
-
Month
-
Day
Year
Date
TYPE SERVICE Attended
In-Person
Online
Other
WORSHIP SERVICE Attended
10:00AM
2:00PM
Other
Name
Prefix
First Name
Middle Name
Last Name
Suffix
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Preferred Contact Method:
Phone
Email
Text Message
I would like to
Accept Christ/Give Life to Christ (conversion)
Follow-up on my Prayer of Salvation
Join Big Bethel AME Church (accession)
Candidate for Baptism (conversion)
Affiliate w/Big Bethel AME Church (retain membership at home church)
Request Special Prayer
Have you already given your life to Christ?
Yes
No
Have you been Baptized?
Yes
No
GENDER:
Female
Male
Date of Birth
MM/DD/YYYY
Age?:
Marital Status
Single
Married
Widowed
1st Time Visitor?
YES
NO
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
Emergency Contact
First Name
Last Name
Relationship
Emergency Contact Phone Number
-
Area Code
Phone Number
Comments: (If applicable, list Spouse and children's information in the comments)
Submit
Should be Empty: