Baby Dedication Registry

C.A.B.C. BABY DEDICATION APPLICATION

420 West 145th Street • New York, NY 10031• Tel. (646) 698-5100
Fax (212) 234-6019 WWW.CONVENTCHURCH.ORG
Rev. Dr. Jesse T. William, Jr., Pastor

Child's First Name

Child's Last Name

Child's Birthdate

Gender

Mother's First Name

Mother's Last Name

Father's First Name

Father's Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Email

Godmother's First Name

Godmother's Last Name

Godfather's First Name

Godfather's Last Name

Additional Comments

Additional Requests

Donation

$35.00 (CABC Member)

$50.00 (Non-CABC Member)

Date Completed

Signature