POG Connect Card

Your name *

Last name

Email address *

Household members

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Phone number *

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MobileHomeWorkOther

Address

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Country

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Street Address

Apt/unit/box (optional)

City

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Postal code

Gender *

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How did you hear about us *

Family member invitation

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Are you interested in...

Joining a connect group for fellowship.

interested in learning more about the Bible in a Bible study.

In having someone call me to pray with me.

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