Kansas Avenue Contact Information Form
 
Please fill out our contact information form. If you wish to transfer your membership to our church, please fill out the form in its entirety.
(*) Denotes required fields
 
New Address/ Update in church directory(shown below)
Visitor
I would like to study the Bible with one of the pastors
Require a Pastoral Staff Visit (sick family member, counseling)
New to the Inland Empire
Please transfer my membership to Kansas Avenue
Transferring from
Please transfer my membership from Kansas Avenue
Transferring to
Receive the Pacific Union Recorder
 
Birth date:
 
Title:
    
First Name*:
 Last Name*:
 
Address*:
  
City*:
   State*:
Zip* :
 
Home Phone:
( ) -
Alternate Phone:
( ) - 		Email:*

Spouse:
First Name
Last Name

Birth date:
Children:
First Name
Last Name 		First Name
Last Name
Birth date:
 Birth date:
   
First Name:
Last Name: 		First Name
Last Name
Birth date:
 Birth date:

Send a message or comments to us:




*The Kansas Avenue SDA Church does not share any information you submit to third parties.
This information is kept confidential and is used solely for the purposes of conducting church business.

 
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