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First Name
Last Name
Email
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New Address?
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Address
Apartment, suite, etc.
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How many times have you visited our church?
This is my first time
A few times
Regular attender
I am a guest of...
Are you a Member of ICC?
Attender
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Current School Age or your Age Group
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Age Group
18-22
23-35
36-40
41-45
46-50
51-60
71+
Marital Status
Single
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MY DECISION TODAY
I’m committing my life to Christ
I want to be water baptized
I am renewing my commitment to Christ
Sign me up for Next Chapter Membership class
I am willing to help where needed
I like to talk to one of International Christian Center’s leaders
I WOULD LIKE INFORMATION ON
How to begin a relationship with Christ
How to join the International Christian Center family
International Christian Center’s Small Groups (Life Groups)
Children’s Activities
Youth Activities
Young Adults Activities
Men Activities
Women Activities
Couples Activities
COMMENTS OR PRAYER NEEDS
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First Name
Last Name
Email
Phone
Address 1
Address 2
Country
City
State
Zip/Postal Code
How many times have you visited our church?
This is my first time
A few times
Regular attender
I would like to learn more about (check all that apply):
Baptism
Volunteering
Membership
Community Groups
Jesus
How did you hear about us?
Anything else you'd like to share?
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