LET’S CONNECT 让我们联系

Name 姓名:

First

Last

"First" 称为名字 "Last" 称为姓氏

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Gender 性别:

Age 年龄:

How would you like us to contact you? 我们如何与您联系？

Phone call 电话
Email 电邮

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Contact no. 联络号码:

Email 电邮:

Address 地址:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Are you attending any church at the moment? 您目前有出席教会吗？

Yes 有
No 无

Which church do you attend? 若有，是哪一间？

Name of friend who brought you 请填写邀请者的姓名:

Contact no. of friend who brought you 邀请者联络号码:

Which church is your friend from 邀请者所属的教会：

Additional comments or remarks 附加评论或备注:

By submitting this form, I give permission to HEAL Singapore to collect, use, disclose or otherwise process my personal data for administration and other purposes, in accordance with the Personal Data Protection Act (PDPA).

呈交此表格表示我准许医治·新加坡布道特会主办单位，根据个人信息保护法案（PDPA)，在行政或相关原因上收集、使用、透露我所提供的个人资料。