Children Names:

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Day: Month: Month: Last Name: Todays Date: Her Name: His Name: Month: Year: Street Address: City: Zip Code: Home Phone: Her Cell Phone: Her Email: His Cell Phone: His Email: Her Employment and Position: His Employment and Position: Month: Day: Day: Grandchildren: Her Hobbies and Interests: His Hobbies and Interests: Any interesting facts about either or both:

Joined Life Group

Her Birthday

His Birthday

Anniversary

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Life Group Directory Information

Please complete the following form to have your information in our class directory. Be sure to select the SUBMIT button when complete the form.

After submitting the form be sure to provide a picture for the directory. Send your picture to:

don@vcswebsitedesign.com  OR  text to 540-664-4496

Join us 9:30-10:45
A200/A201

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