Please print this form and mail it to:

Joy Ministries Niagara
Healing Seminar
PO Box 31019
St. Catharines, ON
L2N 7S5



1. Full Name(Required)

________________________________________________________________________________________________

2. Mailing Address - Street, City, Province, Postal Code (Required)

________________________________________________________________________________________________

3. Phone Number(Required)

________________________________________________________________________________________________

4. Email Address(Required)

________________________________________________________________________________________________

5. Your Church Name

________________________________________________________________________________________________

6. Your Church Address

________________________________________________________________________________________________

7. Your Church - Name of Pastor

________________________________________________________________________________________________

8. Are you active in your church?

________________________________________________________________________________________________