Master's International School of Divinity Seminar Registration Form

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ACADEMIC OR C.E.U. SEMINAR REGISTRATION FORM

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Title

Name

Address

City

State

Zip/Postal Code

MDS Student ID#

E-mail Address

Day Telephone

Evening Telephone

CLICK HERE TO OPEN A SEPARATE WINDOW SHOWING THE CURRENT SEMINAR SCHEDULE. If you have questions or you are uncertain about anything, please call 1-800-933-1445 and ask to speak with Mrs. Jean Trotter.

I am Registering for the following Seminar to be held on the date I have indicated:

First Seminar

Date of the Seminar

Second Seminar

Date of the Seminar

Third Seminar

Date of the Seminar

More than three seminars: If you wish to register for more than three seminars, please please call 1-800-933-1445 and ask to speak with Mrs. Jean Trotter, or email her jtrotter@mdivs.edu.

SELECT YOUR ATTENDANCE STATUS & PAYMENT AMOUNTS

ATTEND AS A REGULAR ACADEMIC CREDIT STUDENT
At this time, I am paying a $40.00 Pre-Registration Fee for each of the Seminars I have indicated above.
The total amount of my Pre-Registration Fee(s) ($40.00 per-Seminar) is:

ATTEND AS A C.E.U. STUDENT

At this time, I am paying a $40.00 Pre-Registration C.E.U. Fee for each of the Seminars I have indicated above.
The total amount of my Pre-Registration Fee(s) ($40.00 per-Seminar) is:

-and-

In addition to paying the Pre-Registration Fee for each of the Seminars I have indicated above is, I am also paying the remaining Seminar Fee (academic or C.E.U.) at this time. The total amount I am paying in addition to the Pre-Registration Fee(s) above is:

-or-

I AM NOT PAYING the rest of the Seminar Fee at this time, but I do realize I MUST PAY the final balance not later than two weeks prior to the Seminar (unless other arrangements have been approved), and that the Pre-registration Fee is not refundable, though it may be applied toward another seminar in the event that I must cancel. However, the actual Seminar Fee is refundable in the event I am not able to attend.

Total Amount I am Paying At This Time
(including Pre-Registration and Seminar Fees):

I am paying by credit card (we accept only Discover, MasterCard or Visa). Type of card:

Expiration Date:

Card number:

Exact Name on card:

Note: If you are uncertain at this point, and would rather speak to someone in person, please call 1-800-933-1445, and inform the receptionist that you need assistance.

Master's International School of Divinity