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Youth Confirmation Application

Name *

First

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

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

Time period of your life you were baptized

Infancy, childhood, etc.

The Chapel of the Cross
304 E. Franklin Street
Chapel Hill, NC 27514
Driving & Parking Directions
Tel: (919) 929-2193

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