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Pure Heart Atlanta REGISTRATION
Starts APRIL 3rd 2020
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
*
Your answer
Address
*
Your answer
Relationship Status
*
Single
Married
Age
*
0 - 18yrs
19 - 25yrs
26 - 30yrs
31 - 40yrs
Over 40
Do you attend a Bible Believing Church?
*
Yes
No
If you answered 'Yes' in the previous question, please state the name of the Church.
*
Your answer
Do you believe in our Lord Jesus Christ?
*
Yes
No
If you answered 'Yes' in the previous question, do you pray in tongues?
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Yes
No
Reason for applying
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Please tell us in not more than 200 words how you believe this program can help you.
Your answer
Please indicate which course(s) you have taken with us
*
Samuel Class
Faith Class
Ezekiel Class
Christ Class
As A Man Thinketh
None
Required
I certify that my answers are true and complete to the best of my knowledge. I agree to pay a tuition fee of $500 before the commencement of The Pure Heart Atlanta.
*
Yes, I agreee
No, I do not agree
Required
I agree to attend ALL the sessions of The Pure Heart Atlanta, and participate fully in all tasks and assignments given.
*
Yes
No
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