Family name:

Given names:

Date of birth:

Today's date:

Marital status:

Sex:

Name of head of household:
(if more than one member in family)

Res. address:

Res. phone:

Occupation:

Business phone:

Mobile phone:

Email address:

I want to know more about Jesus Christ.

I today publicly accept Christ as my personal Savior and Lord and request believer’s baptism.

I already know Christ as my personal Savior and today request believer’s baptism.

I request consideration for membership on promise of letter from a sister Baptist church (please write name of church below).

I request consideration for membership on statement of immersion baptism and membership in (please write name of church below).

I request Associate status while retaining membership in a Baptist Church outside of Hong Kong (please write name of church below).

I request Watchcare while in Hong Kong. I am a member of the following evangelical church (please write name of church below).

Name & address of church:

Rev. 2004-09-15