Level One Registration

Community Service Chaplaincy Training Registration

Level One Training- Pennsylvania

First Name:

Middle Initial

Last Name:

Email:

Phone:

Street Address:

City:

State/Province:

Zip/Postal Code:

Country

Info

Registration Fee:

Individual: $360

Married Couple: $510

Fee includes certification, background check, and ID card. If paying via PayPal, first complete this form and click the "Submit Registration" button below, then use the PayPal button to pay.

A deposit of at least $50 is required in order to receive your course materials.

The remaining balance must be paid in order to recieve certificate and ID card.

I am registering for label:

I am registering for:

I am registering for:

Spouse's Name:

Spouse's Email:

I am paying via label

I am paying via:

I am paying via:

PayPal

Check

Mail Checks to:

Mail Checks to:

COG CSC

900 Walker St. NE

Cleveland, TN 37311

In order for us to receive your registration, you must click "Submit Registration" below before paying via Paypal.