PureSpring Institute Course Registration Form 2011-2012

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1. Please complete a separate Registration Form for each applicant and each form.
2. Please submit non-refundable Registration Payment online or by mail.
3. Please download Pastoral Recommendation Form and have completed by your pastor or ministry leader and returned to PureSpring Institute.

Course Number *

e.g. SPL1000

Course Name *

e.g. Prophetic Leadership Principles

Have you submitted your Registration Payment? *

Yes

Special Arrangements

Additional Comments

Course Term *

Personal Data and Information

Applicant's First Name *

Applicant's Last Name *

Street Address *

City *

State *

Zip *

Daytime Phone Number *

Email Address *

Church & Ministry Involvement

Church Name *

Church Address *

Church City, State, Zip *

Telephone *

Pastor's Name *

Have you submitted a Pastoral Recommendation? *

Yes

In the mail

Ministry Involvement *

Tell us about your church/ministry leadership role, duties, and period of time involved.

Thank you for completing the Course Registration Form!

We will contact you shortly to confirm that your Application is complete!

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