GracePoint Plant City

Connect Card

Connect Cardpage 1 of 1
Select all that apply
Yes
No
Select all that apply
Mr. & Mrs.
Mr.
Mrs.
Ms.
Dr.

First Name Last Name
Click in box to select date

First Name Last Name
Click in box to select date
Phone Number
Phone Number
Email Address
Email Address
Select all that apply
Single
Married
Widow
Widower
Address
Address Line 2
City State Zip Code
Phone Number

First Name Last Name
Click in box to select date

First Name Last Name
Click in box to select date

First Name Last Name
Click in box to select date

First Name Last Name
Click in box to select date
Select all that apply
1st Time Listener/Guest
2nd Time Listener/Guest
3rd Time Listener/Guest
Regular Listener/Guest
Member
Select all that apply
I am committing my life to Christ
I am renewing my commitment to Christ
I am willing help where needed
I am interested in membership
* required