Classs Enrollment Form

Core or Fundamental Classes Enrollment Form

Please fill in the form below to enroll in one of our classes.
Full Name*

First NameLast Name
Preferred Name for Certificate
Phone Number*

Area CodePhone Number
Mobile Number*
E-mail*
Select your Class or Event: (PR) = Pre Requisite*
Please list special requirements if any:
Please provide the name and (preferably mobile) number of a person to contact in case of an emergency:*
Phone Number*

Area CodePhone Number
I give permission for my contact details (email and/or phone no) to be shared with my classmates at the end of class *

YesNo
I have completed pre-requisite classes (if any), with CWSM or an approved institution*

YesNo
Which method of payment will you be using?*

Credit CardOnline Transfer
Please choose which applies to you.*

I am paying in full by Credit Card - I will pay online at https://confirmingword.org/donateI am paying with Debit Card - I will pay online at https://confirmingword.org/donate
Request a receipt

Please send me a receipt
Notes:
Should be Empty:

Core or Fundamental Classes Enrollment Form