| First Name: * |
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| Last Name: * |
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| Age: * |
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| Title: * |
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| Marital Status: * |
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| Spouse Name: (If married) |
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| How many sons do you have?: * |
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| How many daughters do you have?: * |
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| Address Street 1: * |
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| Address Street 2: |
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| City: * |
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| State: * |
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| Zip Code: * |
(5 digits) |
| Country: * |
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| Home Phone: * |
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| Cell Phone: |
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| Statement: |
Yes, I understand that I cannot request a prophecy or a prayer under false name because the Apostle must present my name correctly before the throne of God. Such a violation may cause me to be in disobedience of the ninth (9th) commandment which is "You shall not give false testimony or tell a lie." |
| Email: * |
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