Heartland Communucation
Welcome to Heartland Church! We are so excited that you chose to visit our web site and we hope to see you in one of our worship services real soon. As a church we are committed to meeting the needs of those in the Heartland Community. If this is your first time to visit our site or perhaps you have attended our church lately please take a moment to fill out the Communication Form. We want to get to know you and invite you to come and become a part of the Heartland family.

Senior Pastors

Ken and Dawn Smith



Heartland Communication Form



Month: Day: Year:


New Address:
Salutation:



First Name: Initial: Last Name:


Address: Apt.#


City: State: Country:

Zip Code:

E-Mail Address:

Phone: Hm# i.e. 3334445555 Wk#:
Do You Wish To Be Contacted?
If Yes, how is the best way to contact you?





Is This Your:
I Am an:
Your Current School Grade:
Age:
Please Indicate:

List everyone living in your household:

 
First Name: Last:
First Name: Last:
First Name: Last:
First Name: Last:


I would like to get involved with:
Victory Village Nursery Dept Full Throttle Youth Music Productions of the Heart Bookstore
Ministry of Helps Usher Greeter Ministry Agapao Ministry Heartrock Cafe Office Volunteer
Mountain Movers Young Married Couples Media Dept

My Decision Today: To Christ
I would like information on: How to commit life to Christ Joining the Church How to receive the Baptism of the Holy Spirit

I would like more information about:


Enter your prayer request:


Praise Report:


Comments:



All information you submitted is kept confidential within Heartland Church and is not distrubuted for any reason.

Thank You For Filling Out This Form! Please use the Submit button below now to send you information.


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