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November 1, 2004

__________________________ Unitarian Universalist Church

WELCOME and PLEASE PRINT all information:

Date: ___/____/____

Name(s): ________________________________________

Phone: ________________________________________

Email: ________________________________________

Address: ________________________________________

City: ____________________ State: ____ Zip: ________

Children:

Name: _____________________________ Age: ____ School Grade: ____

Name: _____________________________ Age: ____ School Grade: ____

Name: _____________________________ Age: ____ School Grade: ____

Thank you for coming! Please help us and Check all those that apply:

1) Would like to receive a copy of our newsletter? ____

2) How did you hear about us?

____ Word of Mouth

____ Friend/Relative

____ Yellow Pages

____ White Pages

____ Radio Spots

Newspaper Religion Notes:

The Star: ____ Main Saturday Edition

____ Johnson Co. Supplement

____ Star Advertisement

Other Newspaper ___________________________

Other_______________________________________

Welcome and Thank You for completing this form!

For more information contact interconnections @ uua.org.

Last updated on Friday, April 18, 2008.

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Unitarian Universalist Association of Congregations | 25 Beacon Street | Boston, MA 02108 | (617) 742-2100 | info @ uua.org

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