Freedom Encounter Session Booking Form • Breakthru Life Church

Saved. Healed. Delivered.

Booking Process:

1. Complete this form below. On completion of the form, you will be redirected to make payment.

2. Make payment. You can make use of the online payment link OR EFT using the banking details provided via the response email once your form is submitted.

3. Please EMAIL your Proof Of Payment in order for us to proceed with your booking: freedom@breakthrulife.co.za.

4. On completion of the FORM and receipt of POP, we will confirm a date and time for your session.

Personal Information:

First Name *

Last Name *

Gender *

Date of Birth *

Marital Status *

Email Address *

Mobile Number *

Home Address *

Home Address Line 2

Home City *

Spiritual Information:

Have you accepted Jesus as your Lord and Saviour? *

Have you been baptised in water? *

Have you been filled with the Holy Spirit? *

Which church do you currently attend? *

Are you currently part of a small group in your church? *

Through whom or where did you hear about the Freedom Encounter session? Please provide their name. *

If other, please explain...

Day and timeslot preference:

Preferred time slot (this is dependant on availability); *

Donation Payment:

We have a suggested donation fee of R300 per session. Alternatively, you may donate according to your affordability. Some form of donation would be required to secure your session. Payment can be made to: ABSA Bank, Account Name: Breakthru Life Church, Account number: 1044141368, Reference: FE (Your name), Proof of payment to: freedom@breakthrulife.co.za *

Noted, I will make the R300 donation payment.

Noted, however I will donate according to my affordability.

Breakthru Terms & Conditions:

On completion and submission of this form, you hereby agree to Breakthru's Terms and Conditions and will in no way hold Breakthru Life Church or any of its members liable for your spiritual journey or experiences.
Confidentiality is a fixed constant in these sessions within the pastoral framework of Breakthru Life Church.
It is agreed that you are voluntarily participating in a Freedom Encounter session.
You will be added to the waiting list and contacted when a session becomes available.
Should you have any questions or concerns, kindly contact the office at 011 679 4264 or email freedom@breakthrulife.co.za.

NOTE: The personal information submitted herein shall be used solely for your booking of a Freedom Encounter session.

All information submitted herein shall be used for the purpose stated above, as mandated by law. The Information Officer undertakes to ensure that appropriate security control measures are implemented to protect all the information to be submitted in this form.