NBC Connect Card

Confidential Form Goes Directly To The Pastor

YOU

Today's Date: *

Name: *

Info:

• Male
• Female
• Married
• Single

Date Of Birth:

Phone:

Email:

Spouse's Name:

Spouse's Info:

• Male
• Female

Spouse's Date Of Birth:

Spouse's Phone:

Spouse's Email:

Address:

Address Line 1

Address Line 2

City

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Zip Code

NEXT STEPS

Next Steps: *

• I am committing my life to Christ
• I want to be baptized
• I want to serve the church
• I want to visit with the Pastor
• Please add me/us to the NBC church roster
• Please update my/our info on NBC roster

PRAYER REQUEST/PRAISE REPORT

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