Today’s Date (required)

Your Name-Last,First,Middle(required)

Date of Birth (required)

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Address

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Your Email

Your Home Telephone

Your Cell Phone

Please make the following commitment:

I accept Christ as my personal Savior and Lord and desire to be Baptized.
I have been baptized and desire membership in this church by statement
I am rededicating my life to Christ

Other or additional comments

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