New Pleasant Baptist Church

First Name

Last Name

Email

Phone

Address 1

Address 2

Country

City

State

Zip/Postal Code

Tell us a little more about yourself; names and ages of adults & children at home:

How many times have you visited New Pleasant?
This is my first time
A few times
Regular attender

I am a regular attendee of ______________________ Church

I am a member of _________________________ Church

How did you hear about us?

I came as a guest of ________________________

Any further explanation or something else you'd like to share?

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