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First Name:
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Last Name:
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Birth date:
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Email Address:
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Address Line 1:
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Address Line 2:
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City:
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State:
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Postal Code:
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Country:
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Primary Phone:
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Cell Phone:
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Best Time to Contact You:
(check all that apply)
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Mon-Fri 10am-5pm
Mon-Fri 5pm-8pm
Saturdays
Sundays
Anytime
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Social Networking URL:
(Myspace, Zenga, Facebook, Virb, Friendster, etc.)
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What type of information are you requesting:
(check all that apply)
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Applying for Crossfire MC
Having Crossfire MC minister at my church, outreach, school, or event
More general information about Crossfire MC
Ways of supporting (financially or spiritualy) Crossfire MC
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What is your level of intrest in applying to Crossfire MC:
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I feel called specificly to Crossfire MC
I feel called to the Pacific Northwest
I feel called to Masters Commission
(unsure of which program)
Just Checking It Out
Not At All
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How did you hear about Crossfire MC:
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Any other information you think would be helpful:
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