LIVE CHAPLAIN CLASS REGISTRATION – Texas University of Theology

AFTER COMPLETING THIS FORM:

YOU WILL BE DIRECTED TO A PAYMENT PAGE TO COMPLETE THE $350 COURSE FEE.

PLEASE DO NOT COMPLETE THIS FORM UNTIL YOU ARE READY TO SUBMIT THE PAYMENT TOO.

Full Name (Your materials will be printed with this name) *

Address: Number and Street Name (Where we will ship your materials) *

Address: City, State & Zip Code (Where we will ship your materials) *

Phone Number *

E-Mail *

Date of Birth *

Gender

Emergency Contact ( NAME & PHONE NUMBER)

Are you a credentialed or licensed minister?

Are you an ordained minister?

If you answered yes to either of the 2 questions above, please tell us the organization you are with.

How did you find us? (Name of referral, Facebook, Google etc.) *

Are you a Veteran?

Current Occupation?

Have you ever been convicted of a felony? *

If yes, please explain.

Driver License#, Passport#, or Government issued ID# (A copy of this ID will be requested before class) *

I understand that this LIVE class will only be given in ENGLISH. *

I understand that this class is non-refundable because materials will be custom ordered with my personal information. *

HOW WILL YOU ATTEND THIS LIVE CLASS? *