AFTER COMPLETING THIS FORM, YOU WILL BE REDIRECTED
TO A NEW PAGE TO MAKE YOUR PAYMENT.
THE PAYMENT WILL COMPLETE YOUR REGISTRATION.
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 *
How will you attend this class? * I will attend class in-personI will attend Online through Zoom
Date of Birth *
Gender MALEFEMALE
Emergency Contact ( NAME & PHONE NUMBER)
Are you a credentialed or licensed minister? NOYES
Are you an ordained minister? NOYES
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? NOYES
Current Occupation?
Have you ever been convicted of a felony? * YESNO
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. *
