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Thank you.
   
Personal Information Needed
   
Your Name
Address1:
Address2:
City:
State:
ZipCode:
Telephone:
FAX:
VP:
Church Information Needed
   
Your Church Name:
Select one:         Southern Baptist Church         Other
Address1:
Address2:
City:
State:
ZipCode:
Telephone:
FAX:
VP:
   
Where does God want you to serve:
As what?
   
Comments: