PLEASE FILL OUT THIS FORM TO REQUEST MINISTRY Name * First Name Last Name Email * Phone Country (###) ### #### What Ministry are you interested in? In Person On Line Retreat Brief History Of Your Christian Life * What Do You Require Ministry Into? * Physical Healing Mental Stress Emotional Hurts Fears Or Trauma Addictions Marriage & Relationships Other Brief History Of Prior Ministry/Counselling * I Am Experiencing Difficulty In These Areas * Relationship With God Strongly Disagree Disagree Neutral Agree Strongly Agree Authority Figures Strongly Disagree Disagree Neutral Agree Strongly Agree Church Life Strongly Disagree Disagree Neutral Agree Strongly Agree Marriage Intimacy Strongly Disagree Disagree Neutral Agree Strongly Agree Unforgiveness Strongly Disagree Disagree Neutral Agree Strongly Agree Childhood Trauma Strongly Disagree Disagree Neutral Agree Strongly Agree Health Issues Strongly Disagree Disagree Neutral Agree Strongly Agree Depression Strongly Disagree Disagree Neutral Agree Strongly Agree Pornography Strongly Disagree Disagree Neutral Agree Strongly Agree Addiction Strongly Disagree Disagree Neutral Agree Strongly Agree Thank you! We will contact you soon.
