GBHEM Candidate Registration Form
Name
*
Mr.
Mrs.Ms.
Rev.
Dr.
Prefix
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email
*
VAUMC email preferred
Secondary Email
VAUMC email preferred
District
*
Church Name and City
*
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
Primary Language
Ethnicity
UMC ID
If Available
GCFA ID
If Available
Payment
Choose your payment option below.
To pay online check the box below. If you have a scholarship code enter it below.
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Registration Fee for GBHEM
$
100.00
Credit Card
Submit
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