Judea Church - Salvation Form

WELCOME TO THE KINGDOM OF GOD!
First Name
Last Name
Address 1
Address 2
Country
City
State
Zip/Postal Code
Date

MonthDayYear
Date
Email Address
Phone Number
Please select one of the following

I accepted Jesus as my Lord and Savior todayI rededicated my life to Christ todayI would like to be baptized
By submitting this form I give Judea Church® permission to contact me.
Please verify that you are human*
Should be Empty:

WELCOME TO THE KINGDOM OF GOD!