Bethel Navajo Assembly of God

First Name

Last Name

Phone Number

Email

Prayer request or Anything else you would like to share

Address 1

Address 2

County

City

State

Zip/Postal Code

I said "YES" to Jesus
YES, first time
YES, rededicated my life

I would like to know more about (Check all that apply):
A relationship with Jesus
Water Baptism
Serving
Growing in my faith
Events coming up

How many times have you visited our church?
First time
A few times
Regular attender