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CONFIRMATION INFORMATION SHEET
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* Indicates required question
Date of Application
*
MM
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DD
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YYYY
Full Name
*
Including middle name
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Your email address:
*
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Your phone number:
*
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Type
*
Confirmed
Received
Reaffirmation
Gender:
Male
Female
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Date of Birth
*
MM
/
DD
/
YYYY
City/Town and State of Place of Birth
*
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Current Address
*
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Phone Number
*
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Previous church affiliation, if any. (For example... Baptist, Lutheran, Roman Catholic etc...)
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Date of Baptism
*
Enter info to the best of your knowledge
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Name of Church and Place of Baptism
*
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Denomination of Baptism
*
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Additional Remarks
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