Baptism Registration

First Name*
Last Name*
Address*
City*
State*	AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
ZIP*
Birth Date*	(MM/DD/YYYY)
Home Phone
Cell Phone*
Email*	* We will be corresponding with you about your meeting and baptism through email.
Please state briefly how and when you accepted Christ as your Savior: *
Why do you want to get baptized? Have you been baptized before (since becoming a Christian)?*
Please Select One:*
I am ready to schedule my baptism. (We will email you with available dates.)  I need to speak with someone before I am ready to schedule my baptism.

Once we receive your registration form, we will contact you to schedule your meeting and baptism. If you have any other questions or concerns regarding baptism, please contact grace@gracenorco.org or call the office at (951) 737-1690.