Name:
Email:
Local Phone:
Home Phone:
Birth date:
Dorm: Cuvilly Kerby
Room #:
Home Address:
City:
State:
Zipcode:
School: CAS EDU SPS
Program: Weekday Evening Weekends
Class: Choose... Freshman Sophomore Junior Senior Graduate
Religious Affiliation: Choose... AME Baptist Episcopal Jewish Methodist Muslim Pentecostal Roman Catholic Other if other, please specify:
Worship Participating in Worship Services / Liturgy Lector Eucharistic Minister Altar Server Choir Member: soprano alto tenor bass Instrumentalist, specify:
Faith Enrichment Bible Study Spiritual Direction / Guidance Faith Sharing Group Interfaith Alliance Retreat
Service Projects
Social Events
