Eastern NC Registration

Community Service Chaplaincy Training Registration

Level Two Training- Eastern NC 2025

First Name:

Middle Initial

Last Name:

Email:

Phone:

Street Address:

City:

State/Province:

Zip/Postal Code:

Country

Info

Registration Fee:

Individual: $250

Couple: $425

*$50 of the course registration fee is covered by the NC State Office*

Fee includes certification, background check, and ID card. If paying via PayPal, first complete this form and click the "Submit Registration" button below, then use the PayPal button to pay.

A deposit of at least $50 is required in order to receive your course materials.

The remaining balance must be paid in order to recieve certificate and ID card.

I am registering for label:

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Spouse's Name:

Spouse's Email:

I am paying via label

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PayPal

Check

Mail Checks to:

Mail Checks to:

COG CSC

900 Walker St. NE

Cleveland, TN 37311

In order for us to receive your registration, you must click "Submit Registration" below before paying via Paypal.