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

Delaware Avenue Baptist Church - Buffalo, N. Y.

(] By Baptism 5-8-10 D By Letter from ___________________ __,D"""---'r.""C'.""d"'-----_-J...::....:u'-'---'--/y'I--L/_...i,c.., 1 _ _,_/ ___,.9_7'----2.,,...

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

D By sprinkling

My name In full

(If married woman give first name also)

Address---------------------------------- Zone__ Occupation Asst . Corporation Counsel for City of Bu f. TELEPHONES

Home ________

Business Address

Date May 8 , 1910

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