Name: *

First Name

Last Name

Phone:

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(###)

###

####

Preferred Method of Contact: *

Email

Text

Call

Do Not Contact Me at This Time

I would like more information about:

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Salvation

Someone to Pray with Me

Baptism

Church Membership

Upcoming Services

Children's Ministry

Outreach

My Decision:

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I prayed to receive & have dedicated my life to Christ as my personal Savior

I rededicated my life to Christ

I would like to know more about a personal relationship with Christ

I would like my prayer requests to be shared with:

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Pastor Bert Synan

Peniel Church Family