Christian Health Service Corps

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Thank you for registering for Global Health & Tropical Medicine Overview - ONLINE. Live interactive course sessions are scheduled online between March 2 and May 22, 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 $75 deposit. If you choose to pay a deposit, you will receive instructions on paying the balance via email. If you prefer to register for sessions individually, individual session registration will open two weeks prior to each individual session - please check our website at www.healthservicecorps.org/training.

Please choose one:

Pay course registration fee in full today

$500.00

Reserve a spot in the course with a deposit

$75.00

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:

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: *