Connection Form

Connection Form

We would LOVE to stay connected with you!
Name*

First NameLast Name
Email*
example@example.com
Phone*
I am a:*

MemberRegular AttendeeVisitor (Please share your contact info below)Other
Names of family members attending with me*
Type "None" if no one is attending with you
I am submitting this form because:

ATTENDANCE, 1st SERVICE: I attended the 8:30am worship service todayATTENDANCE, 2ND SERVICE: I attended the 11:15am worship service todayATTENDANCE, LIVESTREAM: I watched the Livestream of the worship service todayCONTACT INFO: I have new info for your records (please see below)PHOTO: I have a new photo for the directory (upload below)NEWSLETTER: I'd like to receive the Email Newsletter (sent Wednesdays)PRAYER REQUEST: Please pray for me (details listed below)PASTORAL CALL: Please have a pastor contact me (list reason below)KNOWING CHRIST: I would like more info about how to begin a relationship with Jesus ChristOther
Please also provide assistance with:

PRAYER CHAIN: I'd like to receive the daily prayer requests via email so that I can pray for themCOUNSELING: I would like more info about receiving counselingBAPTISM: I would like to get baptizedCHILD DEDICATION: I would like to get my child dedicatedMEMBERSHIP: I'd like to become a member of Ebenezer BFCSMALL GROUP: I would like to join a Kinship Group or Bible StudySERVING: I would like more info about ways to help out at Ebenezer BFCOther
DIRECTORY PHOTO: add/update my family's photo(s)*

Browse Files
click here to attach photo file Cancelof
I heard about Ebenezer Bible Fellowship Church from:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date

MonthDayYear
Grade in School (If applicable)
Wedding Date (If applicable)

MonthDayYear
I would like to add information for my:

SpouseChildren
How Many Children?*
SPOUSE'S INFORMATION
Spouse's Name*

First NameLast Name
Spouse's Email
example@example.com
Spouse's Cell Phone Number
Spouse's Birth Date

MonthDayYear
Date
CHILDREN'S INFORMATION
Name - Child #1*

First NameLast Name
Birth Date - Child #1

MonthDayYear
Date
Email - Child #1
example@example.com
Cell Phone Number - Child #1
Name - Child #2*

First NameLast Name
Birth Date - Child #2

MonthDayYear
Date
Email - Child #2
example@example.com
Cell Phone Number - Child #2
Name - Child #3*

First NameLast Name
Birth Date - Child #3

MonthDayYear
Date
Email - Child #3
example@example.com
Cell Phone Number - Child #3
Name - Child #4*

First NameLast Name
Birth Date - Child #4

MonthDayYear
Date
Email - Child #4
example@example.com
Cell Phone Number - Child #4
Name - Child #5*

First NameLast Name
Birth Date - Child #5

MonthDayYear
Date
Email - Child #5
example@example.com
Cell Phone Number - Child #5
Name - Child #6*

First NameLast Name
Birth Date - Child #6

MonthDayYear
Date
Email - Child #6
example@example.com
Cell Phone Number - Child #6
Comments/Questions/Prayer Requests:
If you are submitting a prayer request, would you like us to share it with the prayer chain (email & text to over 300 people)?*

YESNO, only share it with the pastors
Please verify that you are human*
Should be Empty: