Recommitment to Jesus

Congratulations on your decision to make Christ the Lord and Savior of your life! We want to know so that we can support you in prayer and also provide you some materials that will help you get started in your new walk with Christ.
First Name: *
Last Name: *       Suffix:   

Email Address: *

Birthdate: *    
Age Level: *

Adddress Line 1: *
Adddress Line 2:
City: *
State: *
Zip: *

Home Phone:  )     (xxx)xxx-xxxx
School Name:

Do you currently attend a church?     

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