Christian Health Service Corps

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Suture Workshop
June 22, 2019

Thank you for registering for the CHSC Suture Workshop. This registration page is for the suture workshop on June 22, 2019 only. If you would like to register for the entire Global Health and Tropical Medicine Course, which includes the suture workshop, please click here.

REGISTRATION

Qty

Description

Amount

Total

Suture Workshop

$39.00

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

Total: $39.00

Registrant Information

Registrant Name: *

If registrant address is the same as Payer Information, please answer information after zip code.

Address:

City:

State:

Zip Code:

Cell Phone: *

Home Phone: *

Email: *

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: *

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: *