WLA Connection Card

• Your Name*
  First Name

  Last Name
• Your E-mail*
   
• Phone Number
   

  (###)

  -

  ###

  -

  ####
• Address
  Street Address

  Address Line 2

  City

  Province / State / Region

  Postal Code / Zip

  Antigua and BarbudaBahamasBarbadosBelizeCanadaCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNicaraguaPanamaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColumbiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosCongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauCôte d\'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandTanzaniaTogoTunisiaUgandaZambiaZimbabwe

  Country
• Can we add you to the WLA congregational email list? We send out emails weekly to update on events happening at the church, to share information from our staff and elders, etc.*
  Yes

  No
• Date you attended WLA
  MM

  /

  DD

  /

  YYYY
• Which service did you attend?
  >9:00AM11:00AM
• How did you hear about WLA?
• Please indicate which of the following programs would be of interest to you and/or your family and the respective leaders will be in touch soon.
  Please select all that apply.
  Children's Programs

  Youth Programs

  Young Adult Programs (18-25ish)

  Women's Ministry Programs

  Men's Ministry Programs

  Forevergreen Programs (Retirees)
• I am interested in...
  Please select all that apply.
  Connection Lunch (a get-to-know-you event for newcomers)

  WLA 101 (an event to learn about the history of WLA and what we believe)

  Baptism Class

  Membership Class

  Giving to WLA

  RightNow Media Subscription (FREE)
• Please let us know if there's anything else we can help you with.