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Water Baptism Application

I have accepted Jesus Christ as my own personal Saviour and believe that I have been born again by the power of God.  I now wish to be obedient to the command of the Lord Jesus Christ in Matthew 28:19 to be baptized in the name of the Father, and of the Son and of the Holy Ghost.

 

First Name*

Last Name*

Address*

Address 2*

City*

State/Province*

Zip/Postal Code*

Email Address*

Phone

Date of Salvation*

Date Submitted*

Date of Baptism - Office Use

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