Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Email* Phone*Best time to contact you?Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you a member of Threshold Church?*YesNoIf not, how long have you been attending?How did you hear about Threshold Church?*Describe your testimony and relationship with God.*Describe why you are seeking deliverance ministry. What areas are you needing freedom in?*How long have you been experiencing this?*Have you ever received counseling or ministry for this in the past? If so, when and what was your experience?*Are you aware of anything that may have given access to demonic influence in your life? If so, briefly explain:*PhoneThis field is for validation purposes and should be left unchanged.