Name *

First Name

Last Name

Phone *

(###)

###

####

Please Tick All That Apply

I am new to Revolution and would like to know more

I am interested in Connect Groups

I am interested in Baptism

I would like a giving number

I am interested in Discover Revolution

I am interested in joining a team

This is the first time I've made a decision to become a Christian

I have been away from God and today I am reconnecting

Do you live in Christchurch? *

Yes

No

Name *

First Name

Last Name

Do you live in Christchurch? *

Yes

No

Name *

First Name

Last Name

About *

Tick all that apply

Gatherings

Kid's Programmes

Connect Groups

Discover Revolution

Join a Team

Giving

I'd like to meet the team

Who is Revolution Church

Venue Hire

Other

Do you live in Christchurch? *

Yes

No

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Date of Birth

MM

DD

YYYY