Please Check One *

I am interested in scheduling baptism for my son.

I am interested in scheduling baptism for my daughter.

I would like to discuss/schedule my own baptism.

Name of person being baptized *

First Name

Last Name

If child, name of parent

First Name

Last Name

Name of second parent if applicable

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

Only if for child baptism

MM

DD

YYYY

I/we am/are *

(a) member(s) at MUMC

regular attendee(s) at MUMC

Preferred date for baptism

MM

DD

YYYY