Connection Card
Please complete this Connection Card & click submit.
Name
*
Birthdate
*
Phone
*
Email
*
This address will receive a confirmation email
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
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DC
DE
FL
FM
GA
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HI
IA
ID
IL
IN
KS
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LA
MA
MB
MD
ME
MH
MI
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NB
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OR
PA
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WA
WI
WV
WY
YT
Gender
*
Please select one option.
Male
Female
Non-Binary
Prefer Not to Say
Attendee Type
*
Please select all that apply.
Impactor
Attendee
First Time Visitor
Would you like to know more about?
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Children & Youth
Mvolve (Volunteering)
Connection Groups
Ignite (Membership)
Baptism
Care & Wellness
Impact Gives Back (Local Missions & Outreach)
Impact Scholarships
How would you like to be contacted?
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Email
Phone Call
Text Message
STAY CONNECTED! Get the latest updates from Impact Church events, experiences, and programs.
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Yes, Keep me Connected!
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Description
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