NRBChurch ONLINE VISTOR CONNECT FORM

An Online Form for Visitor Information and Everyones Prayer Requests

First Time Visitor? *

Todays Date (__/__/____) *

Name *

First

Last

Spouse Name (If Applicable)

First

Last

Address 1 (Street Address)

Address 2 (City, State, Zip) *

First

Middle

Last

Phone (___) ___ - ____ *

Best Time To call __:__ AM or PM

Email

I Am: (Check All That Apply)

Number of Children Living At Home:

Please List Childs First and Last Name and Current Age

Prayer Requests

Do You Call Another Church Home?

If Yes, would you mind sharing the Name of that church.

How Did You Hear Of Us?

If Other, what might that be?

TODAY I HAVE:

I Would Like To Know How To:

Ministries I Am Interested In

Comments or Questions

1909 Transport Lane, Holland, Mi 49423 | Phone: 616-546-9142 | Email: NRBChurch@NRBChurch