Members Date Name Email Your Salvation Testimony Have You Been Baptized?YesNo Have You Been Baptized in a Baptist Church?YesNo If so, do you remember when and where? If not, where were you baptized? If you have not been baptized in a Baptist Church, are you willing to identify with this church in water baptism? YesNo TitleMr. Miss. Mrs. First Name Last Name Street Address City Province Postal Code Email Present Church Membership Birthday Anniversary Marital StatusSingleMarriedWidowedDivorcedSeperated SubmitThe form has been submitted successfully!There has been some error while submitting the form. Please verify all form fields again.