First Name*
Last Name*
Address*
City*
State*
ZIP*
Birth Date*	(MM/DD/YYYY)
Home Phone
Cell Phone*
Email*	* We will be corresponding with you about your meeting and baptism through email.
Do you believe you're going to heaven? How do you know that? *
Please state briefly how and when you accepted Christ as your Savior: *
Why do you want to get baptized? Have you been baptized before (since becoming a Christian)?*
Baptism is a public profession and symbolizes a death to our old life and our receiving a new life through Christ. Although everyone getting baptized is a sinner, life in Christ should be seen in our daily life. Is your lifestyle reflective of your life in Christ? *
Yes  No  I would like to speak to someone
Please Select One:*
I am ready to schedule my baptism. (We will email you with available dates.)  I need to speak with someone before I am ready to schedule my baptism.  I would like to be baptized at Family Birthday Celebration.  I want to be baptized at the Labor Day Retreat. (Must attend the retreat)

Once we receive your registration form, we will contact you to schedule your baptism. If you have any other questions or concerns regarding baptism, please contact or 678-892-5762.