Rise Ministry Data Form (Members & Guests)

Please fill out this form and click submit.

Today's Date:

*

How did you learn about the NextGen Rise ministry? (check all that apply)

Please select all that apply.

I attend CRBC Someone told and/or invited me Snail Mail Email Social Media Website Other

Are you visiting today as a guest of a Rise member?

*

Please select one option.

Yes (see next field) No

If you answered "Yes" above, please provide the first and last name of the Rise member:

Check all that apply:

Please select all that apply.

I attend college full/part-time. I am in the military. I am employed full/part-time.

Name

*

Nickname or Preferred Name:

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Birthdate

*

Cell

*

Email

This address will receive a confirmation email

Address

*

School Name (College/University):

*

Please select one option.

NOVA Annandale NOVA Alexandria NOVA Loudoun NOVA Manassas NOVA MEC NOVA Woodbridge Averett Bridgewater CNU GMU JMU LU ODU RU Sweet Briar UMW UVA VCU VMI VT WM I do not attend College Other (please see field below)

If you selected "Other" for your college/university, type in your school name here:

2022/23 Academic Year

Please select one option.

Freshman Sophomore Junior Senior

If you are a resident student at your college/university, please share with us your dorm/resident address so we can keep in touch with you while you're away. Thanks! (See next field)

College Address:

Description

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Please Fix the Following

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