« Contact Us Connection Campaign Please Contact Me User Information Name (First, middle, last) * Preferred Name Pronoun * —Please choose an option—He/HimShe/HerThey/Them/Other Would you like a magnetic name tag? —Please choose an option—YesNo How would you like your name spelled on your tag? Contact Information Street Address * City * Zip Email Address Email First Word? —Please choose an option—YesNo Primary Phone * Can we text you at this number? —Please choose an option—YesNo Alternate Phone Can we text you at this number? —Please choose an option—YesNo Emergency Contact Name Relationsip Phone Address Can we share your contact information with known church community members seeking to reach you regarding church business? * —Please choose an option—YesNo Demographic Information We collect this information for reporting purposes to the Michigan United Methodist Conference and to ensure you appear reports specific to these areas. Birth Date * Ethnic Origin * —Please choose an option—AsianAfrican AmericanCaucasianHispanicNative AmericanPacific IslanderMulti-Racial Marital Status —Please choose an option—SingleMarriedDivorcedWidow/WidowerLegally Separated Marriage Date Maiden Name (if applicable) Δ
