Name
Full Address
Birthdate
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Month
/
Day
Year
Date
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Please Select
Married
Single
Widowed
Anniversary Date If Applicable
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Month
/
Day
Year
Date
Email
example@example.com
Phone Number (Personal Mobile or Primary Number)
Church Name where you are currently serving as lead pastors
Church Full Address
Please choose ONE of the following Regional CARE Groups:
Please Select
Augusta North and South, Wrens-Lauren Burton and Patty Baker
Buford-Mia Grizzle and Kathy Milligan
Carrolton, Mt. Holly- Kristi Crowe
Calhoun, Dalton-Stephanie Cooper and April Lester
East Point-Kimberly Worley and Rhonda Daws
Ft. Oglethorpe, Rossville, Summerville-Kaye Edwards
Griffin, LaGrange, Thomaston-Monte Powell and Michelle Davenport
Lavonia-Tina Tripp and Shelly Cash
Lawrenceville, East Atlanta, Tucker-Nita Daigle and Abbie Hendrix
Monroe-Elizabeth Sheppard and Trisha Vismor
Milledgeville, Macon-Lori Milam and Athena Singletary
Northeast Mountain Region-Carla Wright and Lynn Wilson
Rome – East and West-Pam Addis and Joyce Coomer
Marietta, Tri-County, Riverside-Nikita Citizen
Toccoa-Penny Petty and Danette Smith
Trenton- Georgina Tinker
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