Covenant Warriors Conference Seminar Registration Form


Items marked by an asterisk (star) are required.
You can either fill this form out on line or you can download the form and mail it to
Covenant Warriors International Ministries
POB 393
Springtown, Tx
76082



The Deliverance Seminar requires a $25. USD donation and Healing the MPD conferences require a $50.00 USD donation for each person attending to assist in in conferences expenses, outline book, and snacks. Contact CWIM Services at info@covenantwarriors.org to make your donation.

*Full Name:
*Address:
*City: *State/Province:
Country: *Zip Code:
Home Phone: Other Phone:

*Email:(if more than one please separate with commas)
Instant Messenger:(Please indicate the messenger(s) that you use with screen name.)

Web Site:

*Ministry Affiliation:
*Company:
*Church:

Counselor Pastor Therapist Deliverance Minister Layman Minster
Safe House Operator Other Please Specify:

Have you worked with MPD/DID clients in the past?
Yes No
Are you currently working with a MPD/DID client?
Yes No
Are you DID?
Yes No

*I will be attending:
Deliverance Seminar Yes
MPD/DID Seminar Yes

Please place other notes of your attendance here:

The Deliverance Seminar requires a $25. USD donation and Healing the MPD conferences require a $50.00 USD donation for each person attending to assist in in conferences expenses, outline book, and snacks. Contact CWIM Services at info@covenantwarriors.org to make your donation.
May HE bless and protect you on your way here. In the name of Jesus Amen and Amen.