------- REGISTRATION FORM ------

 You may register on-site, but space is limited and admission cannot be guaranteed.

PLEASE print this form and mail with your check.  Thanks!

Type or print your name:

Check One:      (_ Rev.)   (_ Evan)    (_ Mr.)    ( Mrs.)    (_ Pastor)   (_ Dr.)    (Other _________)

Name: ______________________________________________________________________

                            Last                                                        First                                                        MI

Present Address _______________________________________________________________

                                               Number and Street                                               City/St/Zip

Home Telephone (___)  __________________           Work Phone (___) ____________________

Name and Address of your Church/Organization:

_____________________________________________________________________________

                                Number and Street                                                               City/St/Zip

Name of your Pastor:   ____________________________________________________________

Select one morning and evening course, within your curriculum choice

*Note: Wednesday and Thursday Evening classes are the same for Friday Morning

Signature_______________________________________Date_________

Make Checks Payable to: Christian Bible College