Rivanna Community Church

First Name

Last Name

Email

Phone Number

Address

Apartment, suite, etc.

City

State

Postal / Zip 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 - please specify interests below

Membership

Life Groups

Jesus

How did you hear about us?

Anything else you'd like to share?

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