Word of Life Christian Center

Last Name:

First Name:

Address:

City:

State/Zip:

Home Phone:

Email:

Birthdate

Are you a born again Christian?

Yes
No

Are you willing to attend a class on water baptism?

Yes
No

Are you a member of Word of Life?

Yes
No

If not, what church have you been attending?

Do you have special needs?

Yes
No

If yes, please explain?

You will be notified of the class date and the date of the water baptism. Should you have any questions, please feel free to call the church office between 9:00 a.m.-4:30 p.m., Tuesday through Friday.