MODULE 1 REGISTRATION FORM 1. Full Name (will visible on certificate) 2. Registering for module number? 3. Have you born again Christian Believer? Yes No 4. Have you got water baptism? Yes No 5. When? 6. Where 7. Active email (to send certificate) 8. Full Address 9. Subdistrict 10. Post Code 11. Handphone Number (Active) 12. Date of Birth 13. Send Proof of Transfer. Payment IDR 500,000 - BCA: 511 021 7589 14. Your Transfer Payment Name? Send Registration Name
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