* 1. Name:

* 2. Home Address:

* 3. Email:

* 4. Cell or Home Phone Number:

* 5. College/ University:

* 6. Major:

* 7. Have you contacted Campus Ministry?

* 8. If no, would like help doing so?

* 9. Interests & Hobbies: (Select all that apply.)

* 10. Prayer Requests:

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