EmailMe Form - College Connection

Students Name *
First Last
College
Year in College
Student's College Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Student's email:
Students Birth Date
MM / DD / YYYY
May we share this address and information?
Yes, I give permission to share this address with the Bethel Church Family.
No, please do not share this address
Thank you for providing this information
After entering the security code below and clicking submit, you will be redirected to the Bethel Church website.
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