THE ORDER OF JEREMIAH

~ ORDER FORM ~

I am ready to sign “The Order of Jeremiah Statement of Intention” stating that I will be like Jeremiah. I’m hoping to be part of the Grassroots Movement to bring about revival in our beloved country.

I desire my membership kit to be sent to me. ($15.00)

The Membership Kit includes the following:

ü Membership Card

ü Beautiful Lapel Pin with Logo

ü Video of Jeremiah

ü Statement of Intention

~ IN ADDITION, PLEASE SEND ME ~

o A Study Guide of Jeremiah - $19.00

o Illustrated PowerPoint Presentation depicting the Order of Jeremiah - $5.00

o Additional copies of the Jeremiah film for me to recruit others to sign the Statement of Intention - $15.00 each

o An Acrylic Stand for my Statement of Intention - $5.00

o Extra Lapel Pins with Logo - $2.00 each – quantity: _____

Sermons on Tape or CD by George L. Faull

____ Tape - $4.00 _____ CD - $5.00

o “What It Means to Repent” Quantity: _____

o “Putting Repentance in Perspective” Quantity: _____

o “An Obsession for Happiness” Quantity: _____

o “I Have Sinned” Quantity: _____

SEND TO:

Name: ______________________________________________________

Address: ____________________________________________________

City: ______________________ ST: _____ ZIP: ______________

Phone #: ___________________ Email: ___________________________

PAYMENTS MADE TO S.T.S. AS FOLLOWS:

____ MasterCard _____ Visa _____ Discover Card

Name as shown on Credit Card: __________________________________

(If different than above name)

Account Number: _________ - _________ - __________ - __________

Expiration Date: _____________________

Signature: _________________________________________________

____ Personal Check # ___________ in the amount of $____________________

____ Please Bill My Account

The Order of Jeremiah

2766 Airport Road - Peru, IN 46970 - (765) 472-4111 – www.summit1.edu