Connect Card NAME* FIRST LAST ADDRESS STREET ADDRESS CITY STATE StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP PHONEEMAIL PREFERRED METHOD OF CONTACT Call Text EmailDATE OF BIRTH Date Format: MM slash DD slash YYYY PLEASE SIGN MY EMAIL UP FOR: MY DAILY INSPIRATION DAILY DEVOTIONAL CROSSROADS CHURCH eNEWSI'MPLEASE CHECK ALL THAT APPLY A FIRST TIME GUEST UPDATING MY INFORMATION IN FULL-TIME MINISTRY FROM OUT OF TOWN LOOKING FOR A HOME CHURCH FROM ANOTHER CHURCHWHICH CHURCH?HOW DID YOU HEAR ABOUT US? DRIVING/WALKING BY WEB SEARCH INVITE GIFT WRAPPING SOCIAL MEDIA OTHERHOW DID YOU HEAR ABOUT US?(Website, Google, Facebook, Friend, Invitation Card, etcMY DECISION TODAY I AM COMMITTING MY LIFE TO CHRIST I AM RENEWING MY COMMITMENT TO CHRISTPLEASE CONTACT ME ABOUT GETTING BAPTIZED JOINING A SMALL GROUP LEADING A SMALL GROUP VOLUNTEERING PARTNERING WITH CROSSROADS CHURCHMy Prayer Request / CommentsSPOUSE INFOANY INFORMATION YOU’D LIKE US TO HAVE, DIFFERENT THAN THE FRONTHAVE A SPOUSE?NOYESSPOUSE NAME* FIRST LAST SPOUSE PHONESPOUSE EMAIL SPOUSE PREFERRED METHOD OF CONTACT Call Text EmailSPOUSE DATE OF BIRTH Date Format: MM slash DD slash YYYY KIDS & STUDENTSHOW MANY KIDS?00010203040506KID 1 NAME FIRST LAST KID 1 DATE OF BIRTH Date Format: MM slash DD slash YYYY KID 1 GENDERMALEFEMALEKID 1 GRADEPRE-KK010203040506070809101112COLLEGEKID 1 ALLERGIES/CONCERNSKID 2 NAME FIRST LAST KID 2 DATE OF BIRTH Date Format: MM slash DD slash YYYY KID 2 GENDERMALEFEMALEKID 2 GRADEPRE-KK010203040506070809101112COLLEGEKID 2 ALLERGIES/CONCERNSKID 3 NAME FIRST LAST KID 3 DATE OF BIRTH Date Format: MM slash DD slash YYYY KID 3 GENDERMALEFEMALEKID 3 GRADEPRE-KK010203040506070809101112COLLEGEKID 3 ALLERGIES/CONCERNSKID 4 NAME FIRST LAST KID 4 DATE OF BIRTH Date Format: MM slash DD slash YYYY KID 4 GENDERMALEFEMALEKID 4 GRADEPRE-KK010203040506070809101112COLLEGEKID 4 ALLERGIES/CONCERNSKID 5 NAME FIRST LAST KID 5 DATE OF BIRTH Date Format: MM slash DD slash YYYY KID 5 GENDERMALEFEMALEKID 5 GRADEPRE-KK010203040506070809101112COLLEGEKID 5 ALLERGIES/CONCERNSKID 6 NAME FIRST LAST KID 6 DATE OF BIRTH Date Format: MM slash DD slash YYYY KID 6 GENDERMALEFEMALEKID 6 GRADEPRE-KK010203040506070809101112COLLEGEKID 6 ALLERGIES/CONCERNSPost Title Share this:PrintFacebookTwitterLinkedInMoreRedditTumblrPocketSkype
