Name *

Phone number

Email *

Phone

Date / Time

How long have you been a Christian?

Have you received the baptism of the Holy Ghost with speaking in tongues?

What church do you attend or affiliated with.

Are you seeking deliverance? If so tell us why.

Do you need Accommodation? Its free, First come basis * Individual Church or Ministry group

Comment or Message

What Dates will you be coming

How many of you are coming

Name of Organization