Connection Card

Name
First Last
Date
MM slash DD slash YYYY
Age Group
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Child Ages, Names, and Grades
I am a...
- First-Time Guest
- Regular Member
- Regular Attender/Non-Member
I would like information about...
- Visiting with the Pastor
- Right Now Media
- Music Programs
- Activities for Men/Women
- Activities for Youth/Children
- Wednesday Night Activities
- Receive Church Newsletter (The Tidings)
- Learn more about Jesus, Salvation, or Baptism
- More info about UCC/Becoming a member
Would you like to serve?
- Children's Ministry
- Teaching
- Computer Technology
- Social Media
- Nursery
- Wednesday Nights
If there are other ways you'd like to serve, list them here:
Prayer Requests
Name
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101 N Oak Street
California, MO
(573) 796-4885