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Application for Baptism

Full Legal Name:
Miss
Mrs.
Ms.
Mr.
Last: _____________________________First (legal): _______________________Middle Initial: ______
Nickname you prefer to be called if different than above: _____________________________________
Address ___________________________________City ______________State ____Zip ____________
Telephone: ( ___ )__________________

Hours you can be reached at this number: _____________

E-mail address: ___________________________________

Date of Birth:___________________

I have listened to the Saying Yes to Christian Faith CD or attended the class.
Yes
No
Please state your first TWO choices for which service you would like to be baptized at (Sat. night,
or Sunday 8:30a, 10:00a, or 11:30a)
__________________________________________
_______________________________________
Do you have a family member or friend (other than an LCN staff member) who you would like to
perform your baptism?
Name___________________________________________Phone # _____________________________

(Over)

Testimony
Please describe the events that lead up to you becoming a Christian.

How has your life changed since you accepted Christ?

Finish the sentence: I am being baptized today because