| Church/Organization | Pneuma (The Holy Spirit Revival Church) |
| Preferred First Name | |
| Street Address | 1159 Benton Way |
| City | Arden Hills |
| Postal/Zip Code | 55112 |
| Mobile Phone | |
| Home Phone | |
| Office Phone |
| Membership Credential | |
| Mailing List | Yes |
| Marital Status | Divorced |
