Name *

First Name

Last Name

Phone

(###)

###

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I would like more information about:

Please select all that apply.

Membership

Sunday School

Kids Ministry

ROCK Students

Celebrate Recovery

Name *

First Name

Last Name

Phone

(###)

###

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I have decided:

Please select all that apply.

to accept Jesus as my Savior

to be baptized

to join Salem Baptist Church

Name *

First Name

Last Name

Phone

(###)

###

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I would like to serve in:

Please select all that apply.

Nursery

Preschool Ministry

Kids Ministry

ROCK Students

Greeter Team

Media

Office

Thrift Store

Food Pantry