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Baptism Report
This information is being submitted to the conference membership clerk so it can be entered into eAdventist.
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* Indicates required question
Your Full Name:
*
Your answer
Phone:
*
Your answer
Email:
Your answer
New Member
First Name
*
Your answer
Last Name
*
Your answer
Birth Date:
*
MM
/
DD
/
YYYY
Address
*
Your answer
City:
*
Your answer
State:
*
Your answer
Zip Code:
*
Your answer
Demographics
Language Spoken:
*
Choose
English
Spanish
French
Portuguese
Korean
Filipino
Bahasa Indonesian
Japanese
Romanian
Polish
German
Hungarian
Other
Ethnic Background
*
Your answer
Living at the same address of current church member?
*
Choose
Yes
No
If Yes, please enter Full Name of member
Your answer
Marital Status:
*
Choose
Single
Married
Widowed
Seperated
Divorced
Gender:
*
Male
Female
Required
Contact Information
Home Phone:
*
Your answer
Mobile:
Your answer
Email:
Your answer
Membership
Received into the membership of:
*
Your answer
How was he/she received:
*
Choose
By Baptism
By Profession of Faith
By Rebaptism
Date:
*
MM
/
DD
/
YYYY
Officiating Minister:
*
Your answer
Misc.
Occupation:
Your answer
Student:
Yes
No
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