JOSEPH KALEMA MINISTRIES INC. VIRTUAL REVIVAL CONVENTION

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First Name *

Last Name *

ATTENDEE(S) *

Address *

City *

Address 2

Zip/Postal Code (If applicable) *

COUNTRY OR STATE *

Phone Number *

Email Address *

Name of your Church or Ministry? *

What is your Role in that Church / Ministry? *

Have you attended any of our past conferences? * *

THIS IS MY FIRST TIME

YES, I DID.

NO.

How did you hear about this Conference? *

REGISTRATION *

Item A Single ($50.00)

Item B Couple ($90.00)

Number attending *

In future, I would like to get involved /participate in prayer/ intercessory, AS A PRAYER PARTNER IN BRINGING THE WORD AND HOSTING THE PRAYER SESSIONS WITH Joseph Kalema Ministries / CHRIST DOMINION LIFE CHURCH(Executive Host of the program). * *

Yes, I want to be a Ministry Partner.

No, thank you.

Briefly tell us about what you do, as your calling.

Conference SEED Sowing.

Donation towards conference ($10.00)	Donation towards conference ($20.00)
Donation towards conference ($30.00)	Donation towards conference ($100.00)
Donation towards Conference ($200.00)	Donation Towards Conference ($300.00)
Donation towards Conference ($500.00)	Donation towards Conference ($1,000.00)

Other

Current Total:

$0.00

Terms and Conditions *

You consent to receive communications from us electronically. We will communicate with you by e-mail or phone. You agree that all agreements, notices, disclosures and other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing.

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Pastor	Active member	Ministry Team Member
Youth Leader/ Youth Pastor	Deacon	Elder
Bishop	Archbishop	Sunday School Teacher
Intercessor	Choir Member	Choir Music Director
Usher	None of the above. Explain---------------------------------------------