Please complete the following information so that we may pray specifically for you, rejoice with you, and send you any futher informaion.

 

Personal Information...

Name:
Street Address:
City:
State/Province:
Country:
Area Code & Phone:
E-mail address:

How can we assist you? ...

Your Request?	Choose One Prayer Request Praise Report Comments Questions
	Type your information here...
	Add me to the Mailing List.
How did you hear about this web site?	Family Friend Web Site Other:

Miscellaneous...

Are you intereted in more information?	Yes No
Are you interested in hosting a seminar?	Yes No

Would you Partner wtih us?

If you decide you would like to partner with us financially, a one-time gift given, we will send you a free tape of your choice. *All gifts are tax deductible. *

I would like to make a one-time gift in the amount of . Please send me a free tape entitled .

If you decide you would like to partner with us on a monthly basis, we will send you a free book of your choice, plus updating newsletters and articles from myself, my wife, and my children. I would like to make a monthly gift in the amount of . Please send me a book entitled .