Prayer Seminar 2017

* Indicates required field.

Date

dd/mm/yyyy

Name*Name of Person attending the Seminar

First

Last

Gender*

Date of Birth -this is optional, but important.

dd/mm/yyyy

Home Address - this is optional, but important.

Address 1

Address 2

City

Province/State

Postal Code

Country

Age Group *Please select your age group.

Conference Zone *Please select the Conference Zone your church is in.

Name of the Church you are attending*

Prayer Coordinator *Please select your office at church.

Phone Number*

Phone Number 2.if you have two numbers please give us both of them.

Special Requirements

N.B. ABSOLUTELY NO REGISTRATION PROBLEMS WILL BE ADDRESSED AT BALANDRA.