Thank you for taking the time to fill out a connections card.
The only information required to create an account are First Name, Last Name, and Email address,
however providing additional details will allow you to better connect with others in the future.
Only one submission is needed per family but it is best if each spouse have a separate email address.

If you have any difficulties or questions, email us at connect@impactlifechurch.com and we'll try to help you through the process.

For security reasons, the 'DATABASE Web Form' block can only be shown on a page that uses SSL security (https).

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Payment

Payment Summary

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Please click the 'Process' button to complete your submission.


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Submission ID: JIM
Confirmation code: JIM
Select family members to auto add to form:
Jim Smith
Jim Smith