Name:
Address:
Home Phone:
Work Phone:
Fax:
Email:

How did you hear about this seminar:	Mailing
	www.agts.edu
	Pastor
	KADI 99.5 FM (Tolkien seminar only)
	KWND 88.3 FM (Tolkien seminar only)
	Other:

Registration:

If registering persons in addition to the name above, please include the names of additional registrants here:
Registration Fee:	$35 x	# of persons = $
Graduate Credit Option: If you would like to pursue graduate credit for one of these seminars, please contact Geneva Heiskell, AGTS registrar, at 417-268-1000 or register@agts.edu. Available @ $316/credit hour. Each seminar is 1 credit hour. (Price includes registration fee.) Required deposit is $35.
Non-Credit CEU Option: Attendees are eligible for one continuing education unit (CEU) for $50. (Price includes registration fee.)
Total = $

How do you plan to pay?    Check    Visa    MasterCard   Discover

If paying by check, mail payment and a print out of this completed form to:

AGTS Continuing Education
1435 N. Glenstone Avenue
Springfield, MO 65802

If paying by credit card, complete the following:

Credit Card Number:
Expiration Date:
Verification Code:	What is the verification code?
Name as it appears on credit card:
Daytime phone number: