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Cokesbury Census
Family Name
(*)
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Family Address (*)
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Zip Code (*)
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Home Phone (*)
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(*)
Listed
Unlisted
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Family Members (at this address)
Head of Household
(*)
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Email
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Cell Phone
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(*)
Member
Regular Attendee
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Birthday (mm/dd/yy) (*)
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Sex (*)
Male
Female
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Sunday Campus
North
South
West
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Church Community - Please check all that you are
currently
involved in.
Life Group
Sunday Class
Children's Ministry
Youth Ministry
Young at Heart
Bible Study
Singles Ministry
Outreach
Foundation Ministry
Men's Ministry
Women's Ministry
Filling Station
Connecting Ministry
Celebrate Recovery
Congregational Care
Worship Team
Other
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Spouse
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Email
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Cell Phone
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Member
Regular Attendee
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Birthday (mm/dd/yy)
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Sex
Male
Female
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Sunday Campus
North
South
West
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Church Community - Please check all that you are
currently
involved in.
Life Group
Sunday Class
Children's Ministry
Youth Ministry
Young at Heart
Bible Study
Singles Ministry
Outreach
Foundation Ministry
Men's Ministry
Women's Ministry
Filling Station
Connecting Ministry
Celebrate Recovery
Congregational Care
Worship Team
Other
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Child
Invalid Input
School
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Grade
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Birthday (mm/dd/yy)
Invalid Input
Sex
Male
Female
Invalid Input
Sunday Campus
North
South
West
Invalid Input
Church Community - Please check all that you are
currently
involved in.
Life Group
Sunday Class
Children's Ministry
Youth Ministry
Young at Heart
Bible Study
Singles Ministry
Outreach
Foundation Ministry
Men's Ministry
Women's Ministry
Filling Station
Connecting Ministry
Celebrate Recovery
Congregational Care
Worship Team
Other
Invalid Input
Child
Invalid Input
School
Invalid Input
Grade
Invalid Input
Birthday (mm/dd/yy)
Invalid Input
Sex
Male
Female
Invalid Input
Sunday Campus
North
South
West
Invalid Input
Church Community - Please check all that you are
currently
involved in.
Life Group
Sunday Class
Children's Ministry
Youth Ministry
Young at Heart
Bible Study
Singles Ministry
Outreach
Foundation Ministry
Men's Ministry
Women's Ministry
Filling Station
Connecting Ministry
Celebrate Recovery
Congregational Care
Worship Team
Other
Invalid Input
Child
Invalid Input
School
Invalid Input
Grade
Invalid Input
Birthday (mm/dd/yy)
Invalid Input
Sex
Male
Female
Invalid Input
Sunday Campus
North
South
West
Invalid Input
Church Community - Please check all that you are
currently
involved in.
Life Group
Sunday Class
Children's Ministry
Youth Ministry
Young at Heart
Bible Study
Singles Ministry
Outreach
Foundation Ministry
Men's Ministry
Women's Ministry
Filling Station
Connecting Ministry
Celebrate Recovery
Congregational Care
Worship Team
Other
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Do you have other family members who attend/are members of Cokesbury? Please list their names and relationship to you.
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