Online Connect Card

Your name *

Last name

Email address *

Birthdate

Phone number *

Phone type

MobileHomeWorkOther

Address

HomeWorkOther

Country

Country

Street Address

Apt/unit/box (optional)

City

State

Postal code

Household members

(optional)

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How did you hear about Heritage:

Your age group:

Select…18 & under19-20's30's40's50's60+

I am a:

First time guest

Second or third time guest

Regular attender

Do you accept Jesus for the first time today?

Yes!

My next steps today:

I'm beginning a relationship with Jesus

I'm recommitting my life to Jesus

I'm interested in baptism

I'm interested in serving

I would like to talk with the pastor

I'm interested in joining a Connect Group

Other

Prayer requests or comments:

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