New Earth TESTIMONIAL FORM Family Name, Name, “Nickname”: ___________________________________ Cell # _______________ Birthdate: ____________ Gender: __ M __F Civil Status: ___S ___M Religion: _________________ Address: ___________________________________________________________________________ Occupation: ________________________________ Email Address: ___________________________ How did you know about Total Consecration to Jesus thru Mary (TC JM)? ________________________ ___________________________________________________________________________________ Check subject matter: ____ 33 Days Prep. & Day of TC JM ____ Praying TC JM ___ 3 in 1 TC JM Novena ____TC JM Family Cenacle ____Home/ Bldg. Cleansing ___ Healing ____Deliverance ____NE Activity/ Seminar: ___________________________________________________________________ If your testimony is published or posted in the website, is it alright to state your name? ____YES ____NO PLEASE READ INSTRUCTIONS ON TESTIMONIALS before filling up. Pls. type or write LEGIBLY. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ __________________________________________ FULL NAME OVER SIGNATURE Date filled up: ______________________