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Adult Confirmation/Reception Application
Adult Confirmation/Reception Application
Confirmation, Reception or Reaffirmation of Baptismal Vows?
*
Confirmation
Reception
Reaffirmation of Baptismal Vows
Not Sure
Name
*
First
Middle
Middle
Last
*
Last
Name to be used by the Bishop
First
Last Name to be Used
Last
Date of Birth
*
Place of Birth
*
City
Place of Birth – State
*
State / Province / Region
Address
*
Street Address
Address Line 2
Address Line 2
City
*
State / Province / Region
*
ZIP / Postal Code
*
Home Phone
Mobile Phone
Email
*
Baptism Information
Place of Baptism
Church, City, State
Do you know the date of your baptism?
*
Yes
No
Date of Baptism
MM
Date of Baptism – Day
DD
Date of Baptism – Year
*
YYYY
Time period of your life you were baptized
Infancy, childhood, etc.
Confirmation Information
Have you been confirmed?
*
Yes
No
Date of Confirmation
*
MM
Date of Confirmation – Day
*
DD
Date of Confirmation – Year
*
YYYY
Submit