Date *

MM

DD

YYYY

Name *

First Name

Last Name

How many times have you been to Radiant? *

1st Time

2nd Time

Occasional

Regular

Campus *

Canton Campus

Wills Point Campus

Spouse Name

If applicable

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Today my next step is:

Choosing to follow Jesus

Restarting a relationship with Jesus

Please contact me about:

Water Baptism

Growth Track

Volunteering at Radiant