CONNECTION CARD

Name *

First Name

Last Name

Phone

(###)

###

####

Age

0-18

19-39

40-59

60+

How can we help you? *

Check all that apply

I would like to receive email updates from Immanuel

I have a prayer request

I have a question or comment

I would like to talk to a pastor

I would like more information about this church

I have just invited Jesus into my life / want to become a Christian

I am interested in being baptized

I am interested in becoming a church member

I am interested in volunteering in a program or ministry

I would like to update my personal information

Other