Registration Form
Name
Address
City State Zip Code
Phone
Alternate Phone
Email
Emergency Contact Phone
Please indicate how you prefer us to communicate with you:
Letter Phone Email Please do not contact me
How did you hear about Grief Share?
Please share a little information about the person you lost and when the loss occurred:
Church Affiliation: (Please indicate one)
I am a member of Warren Woods Church of the Nazarene I attend Warren Woods Church of the Nazarene I attend a local church in the SE Michigan area I do not currently attend a church
I would like more information about: (Indicate one or more if desired)
Becoming a Christian
Warren Woods Church of the Nazarene
Warren Woods Christian School
Got Questions? Please contact Valorie Bakker using the email form below:
Name:
Email:
Request:
