Register for the
Pneumatikos Night
Healing Class

Pnuematikos Night Healing Services

First Name

Last Name

Phone/Mobile

Gender

Address

House Address

City

State

Country

Nearest Bus Stop

Give us more details about your health conditions

Name of Health Condition

Describe how it affects you

How long has the condition been?

Do you have access to a smart phone to join online classes?

Details about your care giver

First Name

Last Name

Phone Number of Care Giver

Additional details required

Are you a member of Christ Embassy?

Zone

Church

PCF

Name of person that invited you

Zone

Church

PCF

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