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Name *

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Last

Gender *

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Birthday *//

Cell Phone Number *

Home Phone Number

Email *

Email

Confirm Email

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Profile Picture

Deacon? *

Yes
No

Do you recieve the church Text Messages? *

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No

Would you like to recieve the church Text Messages? *

Yes
No

Primary Church *

Primary Language

Education Level/Profession

Marital Status *

Spouses Name *

Spouses Birthday *//

Spouses Phone Number *

Spouses Email

Email

Confirm Email

Spouse Profile Picture

How many children do you have? *

Childs Name *

First

Last

Gender *

Male
Female

Deacon? *

Yes
No

Birthday *//

Childs Grade *

Childs Phone Number

Childs E-Mail

Email

Confirm Email

Childs Picture

2. Childs Name *

First

Last

2. Gender *

Male
Female

2. Deacon? *

Yes
No

2. Birthday *//

2. Childs Grade *

2. Childs Phone Number

2. Childs E-Mail

Email

Confirm Email

2. Childs Picture

3. Childs Name *

First

Last

3. Gender *

Male
Female

3. Deacon? *

Yes
No

3. Birthday *//

3. Childs Grade *

3. Childs Phone Number

3. Childs E-Mail

Email

Confirm Email

3. Childs Picture

4. Childs Name *

First

Last

4. Gender *

Male
Female

4. Deacon? *

Yes
No

4. Birthday *//

4. Childs Grade *

4. Childs Phone Number

4. Childs E-Mail

Email

Confirm Email

4. Child Picture

5. Childs Name *

First

Last

5. Gender *

Male
Female

5. Deacon? *

Yes
No

5. Birthday *//

5. Childs Grade *

5. Childs Phone Number

5. Childs E-Mail

Email

Confirm Email

5. Childs Picture

6. Childs Name *

First

Last

6. Gender *

Male
Female

6. Deacon? *

Yes
No

6. Birthday *//

6. Childs Grade *

6. Childs Phone Number

6. Childs E-Mail

Email

Confirm Email

6. Childs Picture

Website

Location

Address
4405 W. Edinger Ave
Santa Ana, CA 92704

Phone Number
714-775-1234

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