Christian Health Service Corps

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Thank you for registering for Community Health Evangelism Training of Trainers 1 - ONLINE.
You may pay in full today or make a deposit and receive an invoice with instructions on paying the balance.

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

Registration

Course tuition

$220.00

Deposit

Optional: If you would like to reserve your spot in the training with a deposit today and set up payments for the remainder, please enter the code "Deposit55". Your total will be reduced to $55 today and you will receive an invoice with your remaining balance.

Enter Deposit Code: "Deposit55"

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Total: $0.00

Registrant Information

Registrant Name: *

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

Address:

City:

State:

Zip Code:

Gender: *

Age:

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: *