You can always press Enter⏎ to continue
You are very important to us!
Please take 1 minute to submit this form so we can know how to best serve you.
7
Questions
START
1
Name
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
Email
*
This field is required.
example@example.com
Previous
Next
Submit
Press
Enter
3
How may we help you?
*
This field is required.
Check all that may apply!
I'm visiting for the first, second, or third time
I want to become a member of New Vision
I want to give my life to Jesus
I want to rededicate my life to Jesus
I want to be baptized
I want more information about your ministry
Previous
Next
Submit
Press
Enter
4
If you are a visitor, what is the date of your visit?
Or date of broadcast (if watching online)
-
Date
Month
Day
Year
Previous
Next
Submit
Press
Enter
5
Do you have additional comments or prayer requests?
TextSize
Created with Sketch.
Huge
Large
Normal
Small
Bold
Created with Sketch.
Italic
Created with Sketch.
Underline
Created with Sketch.
Underline Copy
Created with Sketch.
Ok
NumberList Copy 2
Created with Sketch.
quote
Created with Sketch.
Break
Created with Sketch.
Image
Created with Sketch.
Ok
Smiley
Created with Sketch.
Previous
Next
Submit
Press
Enter
6
What is the best phone number to reach you?
Area Code
Phone Number
Previous
Next
Submit
Press
Enter
7
Can we text you?
Yes
No
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
7
See All
Go Back
Submit