First Assembly Rapid City - Connection Card

First Name

Last Name

Email

Phone Number

Address

Apartment, suite, etc.

City

State

Postal / Zip Code

I would like to learn more about (check all that apply):

Baptism

Volunteering

Membership

Community Groups

Jesus

I rededicated my heart to Christ today

I would like to have my baby dedicated

I would appreciate a call from a Pastor

How did you hear about us?

Prayer Request

Multiple Choice

Prayer Chain

Pastoral Staff

Praise Report