Clergy Theology Institute Registration

Name *
First *
Last *
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Date *


Please upload your Ordination and/or License Certificate

Phone Number *

Website (optional)
Title or Position in Ministry *
Select the courses you wish to take *
 Psychology- Christian (Monday: 5pm to 7pm) 
 The Man (Tuesday: 5pm to 6:30pm) 
 Leadership/Christian (Thursday: 5pm to 7pm)  
 Biblical Principles (Saturday 10am to 11:30am) 
$75.00 per course. Take two courses for a discounted price of $130.00. Take three courses for a discounted price of $200.00. Take all four courses for $250.00. Members of Clergy Registration Data Commission will receive an additional 10% discount.
Highest Level of Schooling. *
 High School or GED 
 Some College 
 Bachelor's Degree 
 Master's Degree 
 Less than a High School Diploma or GED 
Date of Birth (MM/DD/YYYY) *
Name, address, and telephone of your Ministry. *
Date of Oridination and/or License (if applicable). *
Please give us a brief 'Bio" of yourself. No more than 150-words. *
Are your married? *
Enter your Clergy License Number
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