Reception & Reaffirmation Form
Full Name
Address
(with city, state, zip)
Cell #
Email Address
Date of Birth
MM
/
DD
/
YYYY
Gender
Clear selection
Most Recent Religious Affiliation
Date of Baptism
MM
/
DD
/
YYYY
Name of Church
Location of Church
Date of Confirmation
MM
/
DD
/
YYYY
Name of Church
Location of Church
Name of Bishop
Denomination of Confirmation
Clear selection
Submit
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