Encounter Retreat Registration

Encountering The Supernatural One

Name:*

First

Last

Gender : *

Male

Female

E-mail:*

Mobile Number:*

Area Code

Phone Number

Whatsapp No (if different).:

Area Code

Phone Number

Address:

Street AddressStreet Address Line 2CityPostal / Zip Code

Any Chronic Illness / Medication : *

Name of the church you fellowship at :

The name of your Pastor / Priest :

Registration Amount given : *

Mode of donation : *

Payment reference number :*

I have not paid. I will pay by :

Have you accepted Jesus Christ as your personal Saviour? *

Yes

I have read and accepted the Retreat regulations:*

* Indicates required fields