Connection Card | Convergence Church of Coffeyville

Use this form to let us know about decisions or prayer requests, or to let us know you're here. Please complete the following fields, then click Submit.

Name (Required)

Email Address (Required)

Address

We might like to drop a Welcome Gift by if that's ok

Phone Number

Contact info will not be shared without your permission and will only be used by church staff to contact you.

I am a:

First Time Guest

Regular Attender

Member

Prayer Requests

How can we pray for you?

My Decision Today: I want to...

Let us know if you made a decision today or if you want us to follow-up with you.

Commit my life to Jesus

Get baptized

Renew my commitment to Christ

Become a member

Speak with a pastor

Questions? Comments?

Convergence Church of Coffeyville

906 Elm Street
Coffeyville KS 67337

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