Baptism Request Form

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Name*

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Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Gender*

Age

Date Of Birth*

Requested Baptism Date*

MM slash DD slash YYYY

Contact Person (If different from above)

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Baptism Request Form
Prayer Request

Bethel Adventist Church

1921 N Garey Ave, Pomona, CA 91767-2719

909-629-0106

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Provided by the North American Division and Adventist Connect.

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