Please fill this out if you want to submit an inmate’s/patient’s testimony for publication on the public side of the site.

Downloadable Testimony Consent and Verification Form

    Testimony Consent and Verification

    Your Name (required)

    Your Email (required)

    Local Committee

    To the State Committee:

    Check one:

    I have contacted the person in question and verified that the healing did take place as described and has remained permanent. You have my permission to include on the Public access side of the healing or experience which I have recorded.I am unable to contact this individual, but he/she did give permission for the experience to be shared and I certify that, as far as I can tell, the healing took place as reported.
    Required field:
    I have talked to the individual and by clicking this box, do confirm that I have his/her permission to publish the healing as outlined.