Name *

First Name

Last Name

Phone

Please provide your phone number if you would like us to contact you for prayer and other support.

(###)

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Do you place your faith in Christ? *

Are you willing to place your faith in Jesus Christ as your Savior and receive this free gift of eternal life?

Yes

Would you like to be baptized? *

Baptism signifies before god and the church that you are spiritually cleansed.

Yes

No