Please print all entries except signature

Name of Course for which I am registering........................................

My name is ………………………………………………………………………….. .

I am an Elder at (name of church):

………………………………………………………………………………………………...

My home address is .………………………………………………………………………….

…………………………………………………………………………………………………

My phone numbers are (please include all that apply to you):

home..............................

work....................

cell..............................

fax....................

My email address is: …………………………………………………………………………..

My pastor-mentor is ……………………………………………………………………………

I understand that enrollment in this course requires the submission of this registration form, plus $100.00 in payment to New Castle Presbytery for the full tuition. I also understand that upon successful completion of this course I will receive a certificate indicating so. I promise to attend all class meetings and fulfill all assignments to the best of my ability, and to give the instructor advance notice should illness or emergency prevent me.

Signature.………………………………………………………………………………………...

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