Name: ___________________________ Spouse Name_____________________________
City ________________________________ State _____________ Zip ________________
Home Phone ______________________ Work Phone: _____________________________
Cell Phone: __________________________ E-mail: _______________________________
Driver's License #: ________________________ Date of Birth:______________________
Place of Birth: ___________________________________ Citizenship:________________
Spouses Employment: _________________________ Work Phone ___________________
Employment: ________________________________ Work Phone ____________________
Emergency Contact: ______________________________ Phone: ____________________
Church I Attend: _________________________________ Pastor/Priest________________
Church Phone: _____________________________ Pastor/Priest Phone: ________________
Description of the situation (Use the back if necessary): __________________________________________________________________________
Prescription Drugs I take: ____________________________________________________
I take vitamins & supplements (Name them): ______________________________________
My Physician's Name is:_______________________ Phone: _________________________
My Psychiatrists Name is: _______________________ Phone _________________________
My Counselor's name is: ________________________ Phone:________________________
My general health is: __________________________________________________________
Answer each question. Circle one of the following:
I attend Fellowship on a regular basis? Yes No
I read the Bible on a daily basis? Yes No
I am a born-again Christian? Yes No
I have been baptized in the Spirit? Yes No
I smoke: Yes No
I drink alcohol: Yes No
I drink caffeine: Yes No
I am a vegetarian: Yes No
I exercise: Yes No
I am overweight: Yes No
I hear voices: Yes No
I have night terrors: Yes No
I have night visitors: Yes No
I have been abducted: Yes No
I have seen UFOs: Yes No
I have attempted suicide: Yes No
I have channeled guides: Yes No
I have Astral Traveled: Yes No
I have Remote Viewed: Yes No
I have been Hypnotized: Yes No
I have tried vampirism: Yes No
D & D: Yes No
Pagan/Satanist/Wiccan: Yes No
Voodoo/Santeria: Yes No
Sacrificed animals: Yes No
I talk to the dead: Yes No
I watch Jonathan Edwards on TV: Yes No
I have been levitated: Yes No
What drugs have you used? __________________________________________________
I have been diagnosed as (i.e. bipolar, schizophrenic, MPD, DID, etc.): ____________________
Please send a copy of your psychiatric workup whe possible.
Describe your faith: _________________________________________________________
Parent's History (Include divorce, alcoholism, murder, incest, pedophilia, drug use, witchcraft,
religions, diseases, mental health, suicide, depression, etc. Use the back if necessary): _________________________________________________________________________
Being of sound mind and sound will, I _________________________ (Your Name) have personally contacted pastor Chris Ward and Logos Christian Fellowship in regards to the deliverance of negative spiritual activities that have manifested in my life.
I realize that I need instruction and direction in the area of deliverance and self-deliverance.
I am aware that there are no quick fixes. Most Deliverance takes instruction, knowledge, commitment, time, sacrifice, repentance, and dedication.
I agree to study the information sent to me and be prepared to willfully assist in my deliverance.
I agree not to hold pastor Chris Ward or Logos Christian Fellowship liable for services rendered, or the consequences of such deliverance services.
Should I suffer a heart attack, stroke, paralysis, mental anguish, or any physical, mental, or spiritual disability, I agree not to hold pastor Chris Ward or Logos Christian Fellowship liable for any reason.
I hereby give up my right for any recourse, injunctive action, or law suit for this attempt of spiritual deliverance.
I also agree to let pastor Chris Ward publish and use my story using a fictitious name for any purpose.
Signed ______________________________________________ Date _________________________
Witness Name: _______________________________________ Phone: _______________________
City ________________________________________ State _____________ Zip ________________
Signed: __________________________________________ Date:____________________________
Notary Public: _______________________________________ Date: _________________________
1. Print out this form.
2. Complete it.
3. Get it notarized.
4. Include a current photo copy of your Driver's License or I.D. Card with a current photo.
5. Please include a donation of at least $50.00 if you can to help cover our overhead, phone bills, materials and set up costs. Please make your check or money order payable to Logos Christian Fellowship. If you are facing hard times, then try and send us $5.00 a month until paid or apply to us for a scholarship. We have returned donations to help clients purchase a bus or train ticket and we have even purchased bus or train tickets for clients as warranted and as we can get sponsors. It is not about the money, but we do not live in a vacuum either. Pastor Chris has to live in this world also. Things cost.
A long distance, self-deliverance, costs money, but it can be cheaper than traveling from out of state. Ask yourself this question, what if you suddenly got over 200 applications per month and you had to work full time in order to support your ministry. I am a public school teacher. I do not receive any salary or honorarium from Logos Christian Fellowship? Imagine how much ministry I could accomplish if I were able to go full time. That will take money and lots of it. Also imagine a long distance phone bill that would be a nightmare to the average person. We do not charge for deliverance, prayer, ministry, or counseling, but Logos' still has overhead, utility bills, insurance, and a mortgage. Help us if you can. We are doing all that we can to help you. You should feel comfortable in meeting us half way. If you can afford it, you should send all that you can to support this wonderful necessary ministry that services the tormented on a monthly basis. We need your support. We cannot survive without the generous donations of our saints.
Note: Give cheerfully of your finances. God loves a cheerful giver. During times of tribulation, we frequently 'feel' unloved by God. This is normal but untrue. God is love, God is good. Sin is very complicated and many times we are part of the problem. Remember that there is nothing you can do to make God love you more than He already does. Satan's goal is to make us think God is not Good. Giving to God's work is a tangible way of demonstrating our reliance on God and that we have put Him above self, career, family, or our material well being. "But this I say: He who sows sparingly will also reap sparingly, and he who sows bountifully will also reap bountifully. So let each one give as he purposes in his heart, not grudgingly or of necessity for God loves a cheerful giver. And God is able to make all grace abound toward you, that you, always having all sufficiency on all things, may have an abundance for every good work." 1 Corinthians 9: 6-8. This is taken from How to Stop a Demonic Attack.
6. Go to http://www.logoschristian.org/audio and listen to the tapes on Deliverance and Spiritual Leprosy by evangelist Chris Ward or Frank Marzullo for free.
7. Mail your application and donation to:
If you are hearing voices or seeing hallucinations, I will need the following when possible:
a. A two week food diary.
b. A blood test.
c. A urine test.
d. A hair analysis.
e. A two week exercise journal.
I simply need a good report that itemizes your amino acids and metals. I need to determine is the problem is organically based. Once I eliminate the scientific element than I can proceed with confidence that your problem is spiritually based. Sometimes it is both.
After I have reviewed your case, I will call and interview you, then I will set up a phone appointment. At the phone appointment, you will be required to have at least two strong Christians as witnesses and observers to assist and direct me during the deliverance session. All phone calls will be collect or you may send me a phone card.
Please be patient with us, we are currently about 3 months behind. We receive over 20 serious deliverance inquiries per month.