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GCT COGIC Baptismal Registration (4/30/17)
Please complete the following information and return to the office to receive your Certificate of Baptism.
Email address *
Which age group applies to you (the baptismal candidate)? *
All candidates under age 12 will be screened.
Please enter your first name. *
Your answer
Please enter your last name. *
Your answer
Please enter your name as you would like for it to appear on your baptismal certificate. *
Your answer
Are you registering for the Mass Baptism on April 30, 2017? *
Please enter your date of birth. *
MM
/
DD
/
YYYY
Please enter your address *
Example: 123 East Main St.
Your answer
City *
Example: Memphis
Your answer
State *
Example: TN
Your answer
Zip Code *
Example: 38101
Your answer
If the baptismal candidate is a minor, please enter the full name of the guardian.
Your answer
Primary Contact Phone Number *
Example: (###) ###-####
Your answer
If a minor, is the address listed above the same for the legal guardian?
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