Confirmation

Name*
First Last
Candidate's Preferred Name*
Email*
Phone*
Date of Birth*
MM slash DD slash YYYY
Place of Birth*
City State / Province / Region
Date of Baptism*
Month
Day
Year
Place of Baptism*
Have you been confirmed?*
Date of Confirmation*
MM slash DD slash YYYY
At what church and in which denomination were you confirmed?*
Would you like to be received into the Anglican Communion by our Bishop?*
Have you made a public declaration of faith in Jesus? For example, were you baptized as an adult or adolescent?*