Communication Form - Maple Ridge Christian Reformed Church

Communication Form

Communicate With Us...

About Yourself:

1.

*

Your Full Name:

2.

*

Complete Mailing Address:

3.

*

Home phone number:

4.

*

Email Address:

5.

Marital Status... select...

6.

*

Age Group... select...

7.

List Names/Ages of Children living at home:

8.

*

How often have you visited this website... select one...

(1 required)

	1 X			2X
	3X			Many X

9.

*

Do you attend our church services? select one...

(1 required)

	weekly			once a month
	twice monthly			occasionally
	rarely			Christmas/Easter Services

10.

Enroll me in the next...

Use your Ctrl & Shift keys to select multiples.

11.

I'd like to know more about... counselling...select

Use your Ctrl & Shift keys to select multiples.

12.

I'd like to know more about how to get connected into a small group...select type of group...

Use your Ctrl & Shift keys to select multiples.

13.

I'd like to know more about how to become plugged in as a volunteer... select area...

Use your Ctrl & Shift keys to select multiples.

14.

I'd like to know more about how to get plugged into Special Groups or Activities: select area...

Use your Ctrl & Shift keys to select multiples.

15.

Comments, Request or Prayer Needs: Please indicate if you would like us to submit your request to the prayer team.

Type in the text that you see above: