I would like to become a Cross Rhythms Church Contact.

Mrs Miss Ms
Name  
Address  
Postcode   Daytime Tel
Email  
Date of Birth  
Church  
Minister  
Minister's Signature  

To become a Cross Rhythms Church Contact you must be 16 or over and have your Minister's permission.

Please complete this form and send it to:
Church Contacts, Cross Rhythms, PO Box 1110, Stoke-on-Trent ST1 1XR