REGISTRATION
Friday, February 27, 2026 at 7pm eastern | Service Saturday, February 24, 2024 at 9am - 5pm eastern | Healing Clinic/Workshop Hosted by Healing The Whole Person Inc. & Dr. V. Ministries Location | Tallahassee, FL Life Church 4409 W Pensacola. Street
ATTENDEE INFORMATION
For administration purposes, please complete this form for each individual. Children can be added during check-in, on-site.
YOUR NAME
Mr.
Mrs.
Miss.
Child
Prefix (Mrs./Mr./Child)
First Name
Last Name
YOUR ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
EMAIL ADDRESS
example@example.com
CONTACT NUMBER
Please enter a valid phone number. We will not call you. If we make changes to our scheduled sessions or services, we will update you via text message or email.
WHICH DAYS ARE YOU PLANNING TO ATTEND (CLICK ALL THAT APPLY)?
*
FRIDAY, FEBRUARY 23, 2024
SATURDAY, FEBRUARY 24, 2024
WILL YOU HAVE A GUEST WITH YOU?
*
Yes
No
ADDITIONAL GUEST ATTENDING?
*
Additional Guest Name #1
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #2
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #3
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #4
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #5
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #6
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #7
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #8
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #9
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #10
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #11
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #12
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #13
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #14
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #15
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #16
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #17
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #18
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #19
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #20
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #21
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #22
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #23
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #24
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Additional Guest Name #25
Mr.
Mrs.
Miss.
Prefix (Mrs./Mr./Child)
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
***VIP guest (Pastors & Leaders) & MENTEES*** Please let us know you're coming, so that we can reserve your seat.
*
***VIP Guest (Pastors & Leaders)
***MENTEES***
GUEST
Mail: DR. V Ministries,
P.O. Box 2482, Tallahassee, FL 32316
Zelle:
drvministries@gmail.com
Venmo: @DrVMinistries
Google Pay:
Vyrosierministries@gmail.com
Cash App: $VernetteRosier
Givelify: https://giv.li/041npt
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