Connect Card

We are so glad you joined us today! Please fill out this form to tell us a little about you and your family.

Name

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Email

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This address will receive a confirmation email

Phone

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Address

Phone Carrier (To recieve text updates about Antioch events)

Guest of Antioch Wichita:

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Please select all that apply.

First time guest Been here before

About You:

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Single Adult Married College Student

Spouse's name if married

Age:

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20's 30's 40's 50's 60's Plus

Number of Kids:

Ages of Kids:

Are you currently attending one of our House Churches?

Please select one option.

Yes No

If not attending a House Church, are you interested in joining one?

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Yes No

Please check all that apply:

*

Please select all that apply.

I want to know more about Christ as my personal Savior I am interested in talking to someone about baptism I am looking for a church home I just moved to the area I would like information on becoming a member of Antioch I would like info on resources (food, clothing, medical)

Would you like to be added to the Antioch newsletter?

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Please select one option.

Yes No

Description

We are so glad you joined us today! Please fill out this form to tell us a little about you and your family.

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