New Earth TESTIMONIAL FORM

New Earth TESTIMONIAL FORM
Family Name, Name, “Nickname”: ___________________________________ Cell # _______________
Birthdate: ____________ Gender: __ M __F
Civil Status: ___S ___M Religion: _________________
Address: ___________________________________________________________________________
Occupation: ________________________________ Email Address: ___________________________
How did you know about Total Consecration to Jesus thru Mary (TC JM)? ________________________
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Check subject matter:
____ 33 Days Prep. & Day of TC JM
____ Praying TC JM
___ 3 in 1 TC JM Novena ____TC JM Family Cenacle ____Home/ Bldg. Cleansing
___ Healing
____Deliverance
____NE Activity/ Seminar: ___________________________________________________________________
If your testimony is published or posted in the website, is it alright to state your name? ____YES ____NO
PLEASE READ INSTRUCTIONS ON TESTIMONIALS before filling up. Pls. type or write LEGIBLY.
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FULL NAME OVER SIGNATURE
Date filled up: ______________________