Worship Follow-Up & Requests
Today's Date
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
GENDER:
*
Female
Male
Date of Birth
MM/DD/YYYY
1st Time Visitor?
YES
NO
WORSHIP SERVICE Attended
*
10:00AM
2:00PM
Other
Marital Status
Single
Married
Widowed
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I would Like to
Accept Christ/Give Life to Christ (conversion)
Join Big Bethel AME Church (accession)
Candidate for Baptism (conversion)
Follow-up on my Prayer of Salvation
Affiliate w/Big Bethel AME Church (retain membership at home church)
Receive special prayer
comments
Submit
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