Event/ Class Registrations Form

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Choose a date

Dates

First Choice: (radial button)

Second Choice: (radical button)

Third Choice: (radical button)

What church do you attend?

What is your Pastor's full name?

What is your Church's secretary's name and email address?

Scholarships are available to cover the cost of enrollment it needed.

Do you need a scholarship?

The cost for this 6 -month becoming session is $15. Payment instructions will be provided once your completed registration is received.

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