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Registration Form

*Required fields.
Personal Information:
*Full Name:
*City, *State, *Zip
*Home Phone:
*Email Address:
Church Information :
*Name of Church:
*City, *State, *Zip:
*Office Phone:
*Fax Number:
*Email Address:
*Job Title:
*Are you a member of NACBA?



Seminar Options
Module A ($300)   Module B ($300)     Modules A and B ($575)    

Payment Options

$100 Deposit    $300 Full Payment    $575 Full Payment   

How do you plan to pay?    Visa    MasterCard    Discover    Check

If paying by check, please mail your payment to:

AGTS Continuting Education Office
1435 N. Glenstone Ave.
Springfield, MO 65802


If paying by credit card, complete the following:



Credit Card Number:

Expiration Month:

Expiration Year:

Card Security Code:   What is the card security code?

Name as it appears on credit card:



Updated: Thursday, January 29, 2015 9:55 AM

1.800.467.AGTS • 1.800.467.2487 • Fax: 417.268.1001 • agts@agts.edu1435 N. Glenstone Ave., Springfield, Mo. 65802
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