CTI Registration - Fall 2008 (Pay by Check Form)
Student Information
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First Name
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Last Name
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Street Address
Address Line 2
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City
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State
Alabama
Alaska
Arizona
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California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
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Louisiana
Maine
Maryland
Massachusetts
Michigan
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New Hampshire
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
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Zip Code
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Phone Number
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Evening or Cell Phone Number
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Email Address
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Church Affiliation
Good Hope MBC Member
Good Hope Visitor (non-member)
Personal/Ministry Development
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Choose your Personal / Ministry Development Declaration
Biblical Counseling 101 (self counseling)
Biblical Counseling 101-401 (CTI-H Certification, Credit Hours*)
Developing a Counseling Ministry in your Church
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Course Selection
Early Registration (7/1 to 7/31) - $225.00
Registration (8/1 to 9/8/08) - $275.00
Good Hope MBC Member Discount - $175.00
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Payment Total
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Method of Payment:
I am sending a check (Good Hope MBC, Attn: CTI-H, 3015 N. MacGregor Way, Houston, TX 77004)
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Registrant Information
First-time registrant
Previous registrant
Other
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Indicates Response Required