Evans Smith Registration Form

First Name*

Last Name*

Address*

City*

State*

Zip*

Phone Number*

Date of Birth*

Special Accommodations

Handicapped Accessibility

Other

Visual/Hearing

Emergency Contact:*

Relationship*

Church Name

Pastor's Name

Are you:

Lay Worker/Ministry

Licensed

Ordained

How did you hear about this program?

Do you have a desire to attend seminary?

Yes

Already attended seminary

I would like to register for the following Track Course(s):*

Christian Studies Track

Church Leadership and Administration Track

Ministry Empowerment Track

Theological Preparation Track

By checking the box below, I understand that upon registering in this program I have made a commitment to pay the costs of each class in full and that no CEUs will be issued until full payment is received:*

I understand