Clergy Theology Institute Registration
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| Name
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| Prefix
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| First
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| Last
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| Suffix
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| Address
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| Street Address
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| Address Line 2
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| City
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| State / Province / Region
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| Postal / Zip Code
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| Country
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| Date
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Please upload your Ordination and/or License Certificate
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| Upload
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| Email
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| Phone Number
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| Website (optional)
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| Title or Position in Ministry
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| Select the courses you wish to take
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| 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.
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| Highest Level of Schooling.
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| High School or GED Some College Bachelor's Degree Master's Degree Doctorate Less than a High School Diploma or GED
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| Date of Birth (MM/DD/YYYY)
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| Name, address, and telephone of your Ministry.
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| Date of Oridination and/or License (if applicable).
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| Please give us a brief 'Bio" of yourself. No more than 150-words.
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| Are your married?
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| Yes No
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| Enter your Clergy License Number
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Image Verification
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