Request for Confirmation/Reception/Reaffirmation

Name (first, middle, last)

This address will receive a confirmation email

Phone

Address

Date of Birth

Location of birth (city, state)

Approximate dates for the following are acceptable.

Date of Baptism

Denomination

Church you were baptized in (name of church, city, state)

If applicable: Date of Confirmation

Denomination

Church you were confirmed in (name of church, city, state)

I would like to:

Membership

Description

Please fill out this form and click submit.