Title *

Full Name *

Mobile Number / Whats-App No *

Email Id

Date of Birth (mm/dd/yy) *

Gender *
Female
Male

Marital Status *
Married
Single

Address *

State *

Study Materials are available only in English & Tamil languages-which language would you Prefer ? *
English
Tamil

Education Qualification

Occupation
Yes
No

Are You Undergoing any medical treatment? *
Yes
No

if yes, what type of illness?

Have you attended 10 days / 6 Days Inner healing and deliverance Seminar earlier?
Yes
No

Are You Baptized? *
Yes
No

Have You Received Holy Spirit? *
Yes
No

Your Church Details

Are you involving in Ministry? *
Yes (Full-time)
Yes (Part-time) No

If yes, please specify the type of Ministry