Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone 1

(###)

###

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Cell Phone 2

(###)

###

####

Home Phone

(###)

###

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There are times when someone from the church asks for a directory so that they can send out Christmas cards or contact a church member. Please mark below if you are comfortable with your information being shared or if you would rather it stay private in the church office.

It is okay to share my contact information in a church directory.

I would prefer my contact information to stay private.

Light and Life has a small group ministry called Lifegroups that meet in homes. These groups are a wonderful way to get to know people better in a smaller setting. We would love to connect you with a Lifegroup if you are interested.

Yes, please contact me about a Lifegroup.