Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthday

MM

DD

YYYY

Phone *

(###)

###

####

Do you give Anthem Church permission to share your video story on public platforms that include but are not limited to anthemchurch.com, Facebook, Twitter, and other social media websites? *

Yes, you may share my video story.

No, please do not share my video story.

Is your lifestyle reflective of your new life in Christ? *

Yes

No

I would like to speak with someone

Please indicate your readiness. *

I have watched the baptism sermon, and I am ready to schedule my baptism (We will e-mail you more information and available dates).

I have watched the baptism sermon, and I need to speak with someone before I am ready to schedule my baptism.

I have not watched the baptism sermon (We would prefer that you watch the sermon for applying for baptism).