Name *

First Name

Last Name

Phone *

Country

(###)

###

####

What category best fits your experience?

Salvation Experience or Return to Faith

Physical Healing

Mental Health Healing

Near Death Experience

Deliverance From Addiction

Restoration (Marriage, Family, etc.)

Deliverance from Occultism, Witchcraft, Satanism etc.

Other

How comfortable are you with being filmed? Be honest please. (This only determines how we proceed with pre-production preperation, not if we proceed or not.) *

Not comfortable at all

Somewhat comfortable

Very comfortable

Can we film your interview at your home? *

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Terms *

By submitting this form, I understand that I am voluntarily sharing personal information and elements of my life story with Signs & Wonders. I acknowledge that submission of this form does not guarantee that my story will be featured in any film or project. I also understand that Signs & Wonders may create films or other creative works inspired by a wide range of testimonies and life stories, and that any future creative works may include themes, events, or fictionalized elements similar to aspects of my submitted story. I waive any claim to ownership, control, or compensation related to such creative works, and release Signs & Wonders and its partners from any related liability."

I have read and agree to the above terms.