*Your Name
 
*Your E-mail Address
 
*Phone Number 
 
*Small Group Type
 
*Are you currently in a group?
Yes     No
If yes, who is your group leader?
 
*Childcare Needed?
Yes     No
If yes, please list the name and age of each child below:
 
Questions / Comments
 

  *required

 

 
Bethlehem Church Office
3100 Bethlehem Church Street, Gastonia, NC 28056
P. O. Box 551387, Gastonia, NC 28055-1387
704.823.1600 (phone), 704.823.1278 (fax)