Your name (first & last):

E-mail address:

Street address:

City, state & zip code:

Phone number (incl. area code):

Have you attended Lansing Avenue Baptist Church?
yes    no
Please indicate what you are requesting:
Check all that apply

Information about Lansing Avenue Baptist Church A visit from the pastor    A prayer request or praise I am interested in church membership Other (indicate below)

Please explain what you are requesting: