NBIC Connect

Today's Date

First Name

Last Name

Spouse Name

Last Name

Children 1 First Name

Children 1 Last Name

Children 2 First Name

Children 2 Last Name

Children 3 First Name

Children 3 Last Name

Children 4 First Name

Children 4 Last Name

Phone Number

Country

City

State

How many times have you visited our church?
This is my first time
A few times
Regular attender

I would like to learn more about (check all that apply):
Baptism
Volunteering
Membership
Community Groups
Jesus

How did you hear about us? 

Anything else you'd like to share?