PARTNERSHIP UPDATE

PARTNERSHIP UPDATES

Thank you for updating your information. This assist us in keeping you informed and updated on Inclement Weather and Important Announcements.

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

SPOUSE NAME (IF APPLICABLE) *

First

Last

HOME PHONE *

CELL PHONE *

CAN WE TEXT YOU UPDATES? *

Yes No

Email *

By opting into SMS from a web form or other medium, you are agreeing to receive SMS messages from Kingdom Empowerment Christian Church. This includes SMS messages for appointment scheduling, appointment reminders, post-visit instructions, lab notifications, and billing notifications. Message frequency varies. Message and data rates may apply. See privacy policy at http://www.theempowerment.org. Message HELP for help. Reply STOP to any message to opt out.

NUMBER OF CHILDREN (UNDER 18) *

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