Summer Course Registration Form

Summer Course Registration Form
You may save your progress and return to this form at any time by clicking the Save button at the bottom. You will be emailed a link to the email address provided. When you are ready to continue, click on the link in the email.
Contact Information
Name*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
PID #*
If you do not know your PID#, reference a recent grade sheet or contact the Registrar at GBHEM at cosregistrar@gbhem.org to request it.
Date of Birth*

MonthDayYear
Date
Conference*
District*
Email Address*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.
Have there been any changes in your personal information including address, phone, email, appointment or emergency contact since your last class at Course of Study School?*

YesNo
Due to these changes, you will also be required to fill out a new Student Information Form. You will be sent a link via email as a reminder.

Approval Information
District Superintendent Name*
District Superintendent Email Address*

Confirmation Emailexample@example.com
Local Pastor Registrar Name*
Local Pastor Registrar Email Address*

Confirmation Emailexample@example.com
By signing below, I give permission for release of my grades to the Division of Ordained Ministry, my Annual Conference and my District Board.
Signature

Clear

Pricing Information
TodaysDate

MonthDayYear
Date
Deadline1 (early registration)

MonthDayYear
Date
Deadline2 (end of registration)

MonthDayYear
Date
Late Fee
AmountDue
${amountdue}.00 is due with your registration. Please make check payable to WV Conference Treasurer and mail to WV Conference of the UMC, Attn: Paula Koontz, PO Box 2469 - Charleston, WV 25329. Payment must be received within 21 days of submitting your registration.
Please note that an additional late fee of ${lateFee}.00 will be included in the amount due in your bill from the COS Registrar.
Should be Empty:

Contact Information