A. Contact Information Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Cell Phone (###) ### #### Home Phone (###) ### #### Work Phone (###) ### #### B. How are you connected to our worshiping community? 1. Do you regularly attend weekend services at Grace? * Yes No 2. Are you a member of Grace Community Church? * Yes No 3. Are you currently serving or volunteering in any capacity at GCC or in the East County Region? * Yes No If yes, where? 4. Indicate any programs in which you have recently participated: Option 1 Option 2 5. Do your children attend East Gresham Grade School? * Yes No 6. Do you have any friends at Grace Community Church who we may speak with regarding this need? * Yes No If yes, who? 7. How did you hear about us? * C. Current Need Thank you!
