Christian Health Service Corps

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Thank you for registering for the CHSC Point of Care Ultrasound (POCUS) course to be held March 20-21, 2024. Meals are provided to those who are staying on property. Room and board start March 19th through the 22nd of 2024. If you have any questions or concerns, please email us at info@healthservicecorps.org

REGISTRATION

Qty

Description

Amount

Total

Point of Care Ultrasound Course.

$295.00

Room and Board for POCUS Course and Retreat (March 19-22, 2024)

$200.00

Total: $495.00

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: *