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Church Name

Physical Address

Address Line 1

Address Line 2

City

State

ZIP

Pastor's Name

First

Middle

Last

Suffix

Church Contact Information

Phone

Website

Email

Mailing Address

Mailing Address Line 1

Mailing Address Line 2

City

State

ZIP

Geographic Location

Enter the latitude and longitude of the church's physical location or meeting place. If you have javascript enabled, these fields will be automatically filled out based on the address you enter.

Latitude

Longitude

Additional Notes

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Entry Title

Your Contact Information

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Name

Email Address