Salvation Decision Form

WORD REVELATION MINISTRIES

(The Citadel of Christ)
LET HEAVEN REIGN OVER YOU

Salvation Decision Card
Online Decision Form: I have decided to give my life to Jesus Christ today

Fill out the form carefully
Believer’s Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mobile Number

Area CodePhone Number
Home phone (optional)

Area CodePhone Number
Work Phone(optional)

Area CodePhone Number
E-mail
Did you say the prayer of salvation?
Are you born again for the first time?
Do you belong to any church?
Would you like to join our Ministry?
Additional Comments

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Name

First NameLast Name
Prayer of Salvation
Please verify that you are human
Should be Empty:

WORD REVELATION MINISTRIES