Seventh-day Adventist Church Illinois Conference

new Baptism Report

Reporting Pastor (Choose)

Church/Company Name

Baptizing Pastor if different from reporting pastor and working in Illinois Conference (choose from drop-down list)

Name of Pastor doing Baptism if not Illinois Conference Pastor (can be local church elder with appropriate Conference President permission)

Choose one:

Date of Baptism

Please check all that apply:

Mr.
Mrs.
Dr.
Ms.
Married
Single
Widow/Widower

New Member Name

Middle Name/s

Choose One:

New Member Date of Birth

New Member Address

New Member Home Phone

New Member Mobile Phone

New Member Email Address

If new member is a minor child, please list parent or guardian names below:

Church Joined (if different from church above)

Church Name and State, if not joining an Illinois Conference Church

Name of Spouse

Other family members:

Ethnic Class

Caucasian
Hispanic
Middle Eastern
African American/African Descent
Asian/Pacific Islander
Native American/First Nation

Mail Request/Permission

Send Lake Union Herald
Send Adventist Review
Allow Promo Mail

Send Report to: (enter your email address, and that of the local church clerk, if you would like a copy of this report to be sent to them.)