Connect Card • Orange County First Assembly of God

Date: *

First Name *

Last Name *

Date of Birth

Gender *

Email Address (PREFERRED) *

Phone Number (Mobile / Cell) *

Mailing Address *

Mailing Address Line 2

Mailing City *

Mailing State *

Mailing Zip Code *

Marital Status *

Anniversary

# of Children:

# of People in Household

How did you hear about our church?

Did you accept Christ today?

Yes

No

Undecided

Did you recommit your life to Christ today?

Yes

No

Undecided

# of Visits

1st Time

2nd Time

3rd Time

Are you looking for a home church?

Yes

No

Are you interested in volunteering?

Yes

Not Right Now

No

Would like more information on (select all that apply):

Prayer Request: