Baptism Registration

Please fill out this form and we will get in touch with you shortly.

First Name*
Last Name*
Address*
City*
State*
Zip*
Birth Date*
Phone*
Email*
* We will be corresponding with you about your meeting and baptism through email.
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)?*
Please select one:*
- I am ready to schedule my baptism. (We will e-mail you with available dates.)
- I need to speak with someone before I am ready to schedule my baptism.

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