Impact Community
A Rethink Church Event
Impact Charlotte
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I would like to volunteer for:*
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Contact Information
First Name:
*
Last Name:
*
Email:
*
Phone:
Cell Phone:
Special Skills or Needs:
Interpreter needed?:
Yes
Primary language spoken:
I attend one of the sponsoring United Methodist Churches:
Yes
Additional Information
Contact Me about Registering Youth, Ages 14-17:
Yes
I certify that I am at least 18 years of age:
*
Yes
Church I attend (if any):
I Would Like a Free T-Shirt:
Yes
T-Shirt Size:
-- please make a selection --
SM
MD
LG
XL
XXL
3XL
4XL
Age:
*
-- please make a selection --
18-34
35-49
50-64
65+
How Did You Hear About This Event?:
*
-- please make a selection --
My Local Church
Friend Invitation
TV Ad
Radio Ad
Billboard Ad
Online Ad
Newspaper Ad
Direct Mail
Email
Social Media
Bus Ad
Other
I will need FREE childcare for the day.:
Yes
I WILL be attending the Celebration:
Yes
Number of Celebration attendees (including myself):
Impact Event Name:
*
Number of Participating Children Attending With Me:
-- please make a selection --
0
1
2
3
4
5
6
7
8
9