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

Delaware Avenue Baptist Church - Buffalo, N. Y.

D By Baptism 00 By Letter from

Central Park H. E . Buffalo

D 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_ _

TELEPHONES

Occupation -------------------------–

Home _______

Business Address Date Aoril 3, 19

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