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ONLINE CONNECT CARD


Please tell us a little about yourself & your family

I am attending for my first time    I am local    I am from out of town

I am attending for the rd/th time

I regularly attend Coast Hills (I consider Coast Hills my home church)

Please update my information (please enter your new, current information below)



MY INFO


Your Name
     Single   Married
Birth Date
     Male     Female
Address
City     State     Zip 
E-mail*

*By providing your e-mail address, you will receive our monthly e-mail updates
Home Phone
     Cell Phone    



SPOUSE INFO  (If applicable)


Spouse Name

Birth Date
     Male     Female
E-mail*

 *By providing your e-mail address, you will receive our monthly e-mail updates
Cell Phone




CHILDREN  (If applicable)


Child #1 Name      Birth Date    Male     Female
Child #2 Name
      Birth Date    Male     Female
Child #3 Name
      Birth Date    Male     Female
Child #4 Name
      Birth Date    Male     Female
Child #5 Name
      Birth Date    Male     Female



Enter the numbers as they
are shown in the image above