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First Name
*
Last Name
*
Birthdate:
*
Street Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Best Email Address:
*
Cell Number:
*
Alternate No:
Preferred Method of Contact
*
Email
Text
Phone Call
Any Method Above
Marital Status:
*
Single
Married
Divorced
Widowed
Gender:
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Male
Female
Prefer Not to Answer
Facebook @ Handle:
*
+
-
Twitter @ Handle:
*
+
-
Instagram @ Handle:
*
+
-
Would you like to connect with Pastor K to introduce yourself or partner in ministry?:
*
Yes. Connect me with Pastor K
No thank you
Yes. Connect me with a ministry leader
No, but I would like to learn more about ministry opportunities
Yes. I want to learn more about the different areas serve and support
I have joined The Mt. PisgahChurch by (please select only one:
*
New to Christianity (I have accepted Christ as my Lord and Savior for the first time)
Watch Care (I have decided to make Mt. Pisgah my church covering while away from my church affliation)
Christian Experieince (I have already accepted Christ and have decided to make Mt. Pisgah my church home)