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The Basics of Healing Prayer

REGISTRATION FORM
All Fields Are Required

Name*

Street Address*

Address (cont.)

City*

State*

Zip*

Work Phone

Home Phone*

E-mail*

The name and address of your church: 

Are you a member? Yes No
Your pastor's name:
Denominational affiliation:

You do not have to be a member of a church to attend.
These questions are for statistical purposes only.

*Statement of Faith
 Do you agree with this statement?
"It is my personal confession that Jesus Christ came in the flesh
and that Jesus is Lord."
 Yes           No

_____________________________________
Sign here to attest to the Statement of Faith

Registrations will be confirmed after payment is received.

Seating is limited to 20 participants. No Onsite Registration.

$125.00 per person 

Total Enclosed (check or money order):
PayPal Account NOT Required for Credit Card Payments

If paying by check or USPS Money Order PRINT two copies of form.
Complete, Sign and Send one copy to the address below:

Heart Communications
P.O. Box 232251, Centreville, Virginia 20120  USA