Name(s) *

First Name

Last Name

Wife Cell *

(###)

###

####

Husband Cell *

(###)

###

####

Address 1 *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Address 2

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Anniversary Date *

MM

DD

YYYY

Are you a follower of Jesus Christ? *

We both are.

Husband, not wife.

Wife, not husband.

Do you attend weekend services at New Life Church? *

Yes (2+ times a month)

Occasionally (1 or less times a month)

No (We do not attend New Life)