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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 4-18-46 D By Letter from -------------------------------------

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

D By sprinkling

My name In full

(If married woman give first name also)

Address ----------------------------------- Zone__

TELEPHONES

Occupation

Home ________

Business Address Date Anril

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