"Perspectives" Application Form

First Name:

Middle Name/Initial:

Last Name:

Email:

Street Address:

City/Town:

Prov/State:

Postal/Zip Code:

Telephone:

Church name:

Gender: male female

Please register for the course of your choice by using the following legend to indicate your level of participation:

Courses (modular format)

B (Bible College credit) C (Certificate) A (Audit)

Comments or Questions:

NOTE: Please also send us a head-and-shoulders photo of yourself by email attachment to .