Name:*
Address:*
Contact number:*
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E-mail:
Date of birth:
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Have you been baptized?
If yes, when/where?
Briefly describe why you want to be baptized
What does it mean to you to be baptized?

Corey L. Kennard, Pastor

P.O. Box 24616

Detroit, MI 48224

www.amplifychristian.church