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_____Reg . _ .. 3681.i ........ Schmidt., ... Arvilla _ .._ ffa-.t-,~

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I WISH to enter into active Christian Service by becoming a member of

Delaware Avenue Baptist Church - Buffalo, N. Y.

0 By Baptism dj: By Letter from

Prospect Ave. Baptist , Buffalo NY ~

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0 By Christian Experience Method of my baptism: 0 By immersion

0 By sprinkling

(Sister of Hrs . John Wild &. Hrs . Roughan)

My name In full

(If married woman give first name also)

Address--------------------------------- Zone_ _

TELEPHONES

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Business Address Date __ D_e_ce_m_b_e_r~ 3~1_,'---"1=9_4=9___ _ _

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