WOW Ministries Questionnaire Form

I want to be baptized.

www.BaptizeMeInWater.org
August 9, 2026
6:30am

Hilton Garden Inn Daytona Beach Oceanfront
2560 N Atlantic Ave.
Daytona Beach, FL 32118
Name

First NameLast Name
Date of Birth (Choose any year you desire!)

MonthDayYear
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Format: (000) 000-0000.
Best time to be reached
Email
example@example.com
Facebook Name
Have you received Jesus Christ as your Lord and Savior?
Please confirm that you would like to be baptized? (Matt. 28:19)
Additional Comments
Should be Empty: