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First Name:
Last Name:
Email:

State:

Gender:
Male Female

Are you Saved?
Yes No

Do you know your spiritual gift/s?
Yes No
If yes, please type in the space below.

Name and address of congregation of your worship?
If yes, please type in the space below.

Do you know your ministry?
Yes No
If yes, please type in the space below.

Do you have any suggestions to help bring about unity?
Yes No
If yes, please type in the space below.

Would you like to be a member of United kingdom of God?
Yes No

Any further comments?

Would you like to make a donation?
Yes No
If yes, please enclose amount in the space below.