Baptism Registration

 

Last Name:

 

First Name:

 

Please Select One

Child
Adult

 

Parent/Guardian's Name:

 

D.O.B.:

 

Age:

 

Are you a member of NMCC? Choose Option Yes No

 

Address:

 

City:

 

State:

 

Zip Code:

 

Email:

 

Contact Phone Number:

 

This is my _________ Phone Number. Choose Option Cell Work Home

 

Best Time To Contact:

 

Additional Coments: