The Tune Playing Is:"Just As I Am"

Working For The Lord Ministries

Salvation Form

This form is used to report your exceptance of Jesus as Lord and Savior
Please Fill in all Blanks that I might send you some Information.


Your Real Name (Required)

Your Email Address (Required)

Your Street address : 
City:State:Zip Code:Country:
Telephone Number:Fax Number:
Date you excepted Jesus:Have You Been Baptized?YesNo
Do You Have a Local Church You Attend?YesNo
Would you like to be on our mail list?YesNo
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