Connect Card

Welcome to Bethany! We're glad you're here.

First Name

Last Name

Birth Date

Gender

Email

Phone Number

Address 1

Address 2

City

State

Zip/Postal Code

Country

Spouse First Name (If Applicable)

Spouse Last Name (If applicable)

How many times have you visited our church?

This is my first time A few times Regular attender Online only

I would like to learn more about (check all that apply):

Baptism Volunteering Membership Community Groups Jesus

Which campus are you interested in?

Bethany Laurel (Main Campus) Bethany Online Campus

How did you hear about us?

Anything else you'd like to share?