Hope-At-The-Well Bible Institute
REGISTRATION FORM
Fall Semester 2021
COST: $100 per 13-week Semester

Class Schedule:
Tuesday Night classes will begin on August 10, 2021, until Tuesday, November 9, 2021,
Thursday Night classes will begin on August 12, 2021, until Thursday, November 11, 2021.


NOTE: * means Mandatory class while others are Electives

TUESDAY NIGHT CLASS *
THURSDAY NIGHT CLASS *
TEXTBOOKS
Name (First, Middle & Last) *
Date Of Registration *
MM
/
DD
/
YYYY
Address *
City *
State *
Zipcode *
Birthdate *
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/
DD
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YYYY
Day/Cell Phone *
Work Phone *
Email Address *
Occupation *
Emergency Contact (Name, Number & Relationship) *
Are You a Member of This Church *
Church Affiliation, Other Than Hopewell *
Have You Taken Formal Courses At Other Churches/Institutes? *
If So, Where? (Name, City, State)
Formal Education
Clear selection
By signing this form, I agree to enclose a registration fee of $10 (Digital signature)
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