Full name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

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I wish to be:

Confirmation: This usually occurs in the Episcopal Church around the age of 12, but is also offered for adults who have been baptized but not yet confirmed. Reception: For Catholics and Lutherans who have been both baptized and confirmed, the Episcopal CHurch offers reception into the church. Reaffirmation: For Episcopalians who have been both baptized and confirmed but would like to renew their baptismal vows in the church

Confirmed

Received

Reaffirmed

Date of birth

MM

DD

YYYY

Date of Baptism

If you do not know the exact date give us your best guess, at least the year.

MM

DD

YYYY