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Baptism and Remembrance of Baptism Service Form
Please fill out one form per person being baptized.
*
Required
Errors
Today's Date:
*
Please choose which Baptism and Remembrance of Baptism Service you are attending:
*
Sunday, March 4, 2012 at 12:30pm
Full name of person being baptized (first, middle, last)
*
Gender
*
Select One
Male
Female
Birth Date
*
Parent(s) names if a child is being baptized
Address Line 1
*
Address Line 2
City
*
State
*
--
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FL
FM
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MH
MI
MN
MS
MO
MP
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VI
VT
VA
WA
WV
WI
WY
ZIP Code
*
Email Address
Primary Phone Number
*
(
)
-
ext.
Sponsor's names
*
Have you taken the Baptism Class?
*
Select One
Yes
No
Is this a Reaffirmation of Baptism?
*
Select One
Yes
No
Please choose what method of baptism you would prefer
*
Select One
Full Immersion
"Scoop and Pour"
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