MEMBER CONNECTION CARD – Grace Communion Surrey Hills

First Name *

Last Name *

Do you still consider yourself part of the GC Surrey Hills family?

Of course! I love being a part of this family!
I do, but I attend somewhere else, or I live out of town. I still want to receive communications.
No, and I'd like opt out of the member directory, please.

Mobile Phone

Home Phone

Email *

This is to receive confirmation of your opting out.

What is your preferred method of communication?

Choose from dropdown.

Address

Address Line 1

Address Line 2

City

State

Zip Code

If married, what is your spouse's name?

First

Last

Do you have children under the age of 18?

If not, go to the next question.

Do you mind sharing how many children you have?

# Children

If you feel comfortable, can you share some simple info about them?

Child #1 Age

Child #2 Name

Child #2 Age

Child #3 Name

Child #3 Age

Child #4 Name

Child #4 Age

Child #5 Name

Child #5 Age

Child #6 Name

Child #6 Age

Do you currently serve in the church? *

What capacity do you serve? Please list all areas. *

We want to ensure there are opportunities for people to serve. Can you let us know why? *

What are areas that you'd be interested in? Or, what are some of your passions or skills? *

PRAYER REQUESTS/QUESTIONS