Baptism / New Believer Form

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Personal Profile

Name

First

Last

Put details as you would like them to appear on the certificate.

Confirm Email

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

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Contact Phone

Date of Birth

Mobile

Age

Christian Experience

When did you become born again?

Please give a brief explanation of your conversion / salvation experience. How did you become born again?

What was your previous church affiliation?

Declaration

I hereby declare that: All the information provided above is true and correct to best of my knoiwledge. I am willing to be a member of the church and to abide by the rules, regulations and doctrines of the church in accordance with the Bible. I am willing to be immersed in water for baptism by the church in accordance with teh Bible. I will pay my tithe and offering in the church according to Malachi 3:10.

I declare

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Name

Date