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School of Urban Ministry Print out this form, fill in all that applies and mail it along with a $25 registration fee to: School of Urban Ministry Name:________________________________________________________________________ Street Address:_________________________________________________________________ City, State and Zip Code:_________________________________________________________ Home Phone Number:____________________________________________________________ Work or Cell Phone Numbers:______________________________________________________ Email Address:__________________________________________________________________ Home Congregation:______________________________________________________________ How did you hear about the school?__________________________________________________ Please briefly explain why you are interested in attending The School of Urban Ministry.
Payment Information: (prices include the registration fee--$125.00 per semester for one person) Amount Paid $________($25.00 registration fee due now, $100.00 due on evening of the first class) Do you need to make payments?_____________________________________________________ Do you need a scholarship? Yes / No If yes, how much are you requesting?____________________ Will you be bringing someone?_______________________________________________________ Were you referred to us by someone?__________________________________________________
Confirmation of your registration will be sent via email if possible, otherwise by US Postal
Service.
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