Name:

Street Address:

City:

State:   Zip:

Day Phone:

Evening Phone:

Email Address:

Home Church Name:

Home Church City, ST:

Enrollment Option:
Enrichment - read texts and attend lectures ($200);
Certificate - complete quizzes, journal, exams and project ($200);
Columbia International University undergraduate/college credit (available to HS Seniors) ($400); or
Columbia Intenational University Graduate Credit ($400).

Text Books:
Reader and Study Guide ($40)

Registration Fee:
Early - if postmarked by 1/5/07 ($10)
Regular ($30)

Location:
South Charlotte: Mondays at Calvary Church
University Area: Tuesdays at University Hills Baptist Church

Discounts (if any):
Each additional family member - please identify other family member who pays full tuition in comment box below ($50 off)
Christian organization paid staff member who registers with two other people - please identify your organization and two other registrants in comment box below ($80 off)
Alumni (registration fee & $200 tuition waived)

Amount to be mailed or charged to credit card (at least $30):

(You can pay by credit card on the next page)

Electronic Signature (Initials):
I understand that my initials typed in the box above represent my signature and my commitment to mail in or pay via Paypal at least $30 now, and to pay the balance in full at the first class, January 16 or 17.