Connection Card

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Preferred Method of Contact

Email

Phone Call

Text

Mail

How did you hear about Roseland Reformed Church?

Website

Facebook

Friend

Other

Get Involved

I would like to become a member

I would like to volunteer

I want to know how my gifts can be used

Next Step

I'm interested in getting baptized

I'm interested in a Small Group/ Youth Group

I would like more information sent to me

I am interested in hosting an event

Confidential

Yes

No