Media Ressource

Response Card

Lastname:

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Firstname:

^*

Category:

Teenager

^*

Gender:

Male

^*

Marital Status:

Married

Street Address:

^*

State:

Select an Option

^*

Zip:

^*

Email address:

^*

Telephone:

^*

First time visitor:

yes; no; Former member; A Member of Emmanuel SDA; Regular attender;

Home Church:

Today I have:

Accepted Christ

I am interested in:

Begining a relationship with Christ; Joining this church family; Helping in a church ministry; Joining the church choir; Taking no commitment,Just visiting for now;

I would like:

To receive a phone call from the pastor or an elder

Questions:

Comments: