PST Board of Trustees Annual Dues Registration

Board of Trustees Annual Dues

Phillips School of Theology

at the Interdeminational Theological Center

700 Martin Luther King, Jr. Drive

Atlanta, GA 30314
Title
Name*

First NameMiddle NameLast NameSuffix
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
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Cell Phone Number*

Area CodePhone Number
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Annual Dues $500.00

Annual Dues$1,000.00

Annual Dues (Other Amount)$25.00

Quantity

Annual Dues (Other Amount) $100.00

Quantity

Total $0.00
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