MRBC Connection Card

How are you attending our service: *

On Campus

Online

Name *

First Name

Last Name

Birth Date

MM

DD

YYYY

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you currently attending a church?

Yes

No

Spouse Name

First Name

Last Name

Spouse's Birth Date

MM

DD

YYYY

My Next Steps: (Check All That Apply)

I prayed and asked Jesus into my life today

I am renewing my relationship with Jesus today

I am interested in being baptized

I am interested in joining this church

I would like a visit from a minister or deacon

My Visit Today:

1st Time Guest

2nd Time Guest

3rd Time Guest

Member/Regular Attender

Child 1 - Name

First Name

Last Name

Child 1 - Birth Date

MM

DD

YYYY

Child 2 - Name

First Name

Last Name

Child 2 - Birth Date

MM

DD

YYYY

Child 3 - Name

First Name

Last Name

Child 3 - Birth Date

MM

DD

YYYY

Child 4 - Name

First Name

Last Name

Child 4 - Birth Date

MM

DD

YYYY

I would like more information on: (Check All That Apply)

Hope's Table

MRBC Kids

MRBC Students

MRBC Young Adults

Grow Groups

Discovering MRBC Class

I would like to know more about a personal relationship with Jesus