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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.

If you are human, leave this field blank.

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

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