Registration Form: The Bethesda Experience

*All information given is confidential*

Your name *

Email address *

Are you a RHEMA Partner? *

Have you given your life to Christ? *

Are you filled with the Holy Ghost with the evidence of speaking in tongues? *

Have you ever experienced the following: *

Addictions, of any kind.

Mood Swings

Difficulties in Relationships

Sexual Abuse

Sexual Dysfunction: sexual addiction or avoidance

No, I have not experienced any of these.

Other

State the one thing for which you would like to receive healing: *

Please include any other information that is relevant to the one thing your seeking healing for? *

A copy of your responses will be sent to your email address.