CONNECTION CARD - ICA Kyiv

Phone number

Please tell us about your visit *

First time visitor

Second time visitor

Online visitor

Regular Attender (In-Person)

Regular Attender (Online only)

Other

Gender *

Birthday

Marital status

Anniversary date

Household members

What language(s) do you speak?

English

Ukrainian

Russian

Arabic

French

Other

I recently made a decision to follow Jesus.

Do you have a prayer request or praise report you would like to share with us?

Do you have any other questions or would you like any other information? We will be happy to answer you!