New BREEZE User Form

Fill out this form to be added to our BREEZE directory. Doing so allows us to send you our weekly Newsletter and contact you for inclusion in a small group and various church ministries. Membership is not required .

Name

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Gender

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Please select one option.

Male Female

Birthdate

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Marital Status

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Please select one option.

Single Engaged Married Divorced Widowed Separated

Married On

Baptism Date

Allergies

Please select all that apply.

Peanut Gluten Milk Eggs Shell Fish Tree Nuts Other...

Other Allergies

Notes

Email

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This address will receive a confirmation email

Phone

*

Address

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Picture for your profile

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Upload (8MB)

Description

Fill out this form to be added to our BREEZE directory. Doing so allows us to send you our weekly Newsletter and contact you for inclusion in a small group and various church ministries. Membership is not required .

Please Fix the Following

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