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Connection Card
Please complete one per person.
First Name
Last Name
Phone
Email
Address
Address Line 2
City
State
Postal Zip Code
Check all that apply:
Male
Female
Married
Single
Age range:
17 and Under
18-24
25-34
35-44
45-54
55-64
65+
My Decision Today
None
I just committed my life to Christ!
I want to be Water Baptized!
I think Impact is my new church home!
How did you hear about us?
Social Media
Friend
Invite Card
Web
Other
I would like to receive information about membership.
Yes
No
Submit
