Christian Health Service Corps

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Thank you for registering for Disaster & Refugee Response: Global Principles & Practice - ONLINE. Live interactive course sessions are scheduled online between March 5 and March 13, 2021. Course access and logistics information will be emailed to registrants within the two weeks before the course start date.

You may pay in full today or reserve your spot in the course by paying a $50 deposit. If you choose to pay a deposit, you will receive instructions on paying the balance via email.

Please choose one:

Pay course registration fee in full today

$300.00

Reserve a spot in the course with a deposit

$50.00

For more information email Info@healthservicecorps.org or call our office at 903-962-4000.

Registrant Information
(If different than donor/payer)

Registrant First Name:

Registrant Last Name:

Registrant Address:

Registrant City:

Registrant State:

Registrant Zip Code:

Registrant Email:

Registrant Home Phone Number:

Registrant Cell Phone:

Please select which type of certificate you would like upon completion of training. *

Donor/Payer Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Home Phone Number:

Cell Phone Number:

E-mail: *

A receipt will be e-mailed to this address.

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *

Name on Account: *

Routing Number: *

Account Number: *