Personal Information

Please select the appropriate answer to each question based on your best answer at this time. 

What is your age?

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* 4. What is your age?

Name (these questions are optional if you wish your answers to remain confidential) 

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* 6. Name (these questions are optional if you wish your answers to remain confidential) 

Telephone:

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* 7. Telephone:

Email Address?

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* 8. Email Address?

Concerning your conversion experience:

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* 9. Concerning your conversion experience:

Have you been water baptized?

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* 10. Have you been water baptized?

Have you received the baptism of the Holy Spirit with the initial evidence of speaking in tongues?

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* 11. Have you received the baptism of the Holy Spirit with the initial evidence of speaking in tongues?

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