Please use this form to register with Center for Prayer Mobilization.
Please make sure that all of fields are completed properly so we can process your
application in a timely manner. Thank you. (* = required fields).
*Email Address:
*Street Address:
*Day Phone:
Evening Phone:
Referred By:
Currently Attending Church?: Yes No
If Yes, Name Of Church:
Number of People:
Important Note: A $100 deposit required at time of registration.
Deposit refundable if cancellation is a minimum of 30 days prior to Ministry date.
Registration confirmation subject to date availability.
Deposit Payment by: Credit Card / Paypal Mailing a Check