Register for the

INNER HEALING COURSE

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Classes will start on Thursday, Sept 2, 2010

Registration Form

Print this form, fill it out and mail it to us or bring to Church

You can also Fax it to 973-866-0211

If you are paying by Credit/Debit Card

We accept VISA & MASTER CARD

Name: ________________________________________________________________

Address: ______________________________________________________________

City: ________________________________ State _____________ Zip ___________

Email _________________________________________________________________

If paying with Visa or Master Card fill in this section:

Your Card #: ______________________________________Exp Date: ___________

                 3 Digit Security #'s on back of card: __________

 Signature: _____________________________________________________________

If paying by check simply make it out to

Living Water Church

Enclose it with the form or bring it to Church

 

Questions? Call me at 973-338-6627 or email me: Bishop Dupree