Back To RMCM Ministries    Back To Seminar Schedule

RMCM Ministries - Seminar Registration Form
(All Data Fields Must Be Filled In)

DO NOT USE THE ENTER KEY TO MOVE BETWEEN THE FORM ENTRY FIELDS.
USE YOUR MOUSE, OR TAB KEY and fill the form out completely. You will find the SUBMIT button at the end of the form

PERSONAL INFORMATION

Your Name:
Street Address: City, State, Zip Code:
Contact Telephone Number: Best Time To Contact You:
Your Email Address:

RESPOND TO THE FOLLOWING: (Check All That Apply)
I am a born again Christian/Believer
I am age 18 or older
I am currently working in a counseling practice or ministry
I am a commissioned, licensed, or ordained minister
I am interested in obtaining ministerial credentials
I desire to develop a Christian counseling ministry in my church or in my community

Highest Education Level Attained: (Check Only One) HS/GED Some College Associates Bachelors Masters Doctorate

I Am Registering For: Created In God's Image Seminar

Seminar Pricing: $49 (Individual) and $39 each (Group of 3 or more)
At Which Location?

How Will You Be Paying? Check By Mail Money Order By Mail PayPal Credit Card By Phone Credit Card Online
Payment Amount?

By Mail: Send Check/Money Order to: RMCM Ministries, 207 North Spring Street, Odon, IN 47562
By PayPal: Send PayPal payment to mdesigns@dmrtc.net . Please add $5.00 per person to defray cost of PayPal fees.
Credit Card (By Phone): Submit registration form, then call 1-877-885-2735
Credit Card (On Line): Fill Out Credit Card information below, before submitting registration form.

CREDIT CARD INFORMATION

Credit Card Company?
Credit Card Account Number? (15 or 16 numbers from the face of your card)
Credit Card Expiration Date (Month/Year)?
Billing Name As It Appears On Your Card
Billing Address On Card (Street, City, Zip Code)

I agree to pay all credit card payments in accordance with my credit card company policies and procedures.
I understand that this charge is subject to a 3% processing/convenience fee.

Important Notes:

  • A full refund is offered if cancelled 30 days or more prior to the registered event.
  • A partial refund is offered 15 -30 days prior to the registered event.
  • No refunds are offered within 15 days of the registered event.
  • Each seminar has a target participation goal. If that goal is not met, the event is subject to cancellation. If this should happen, all registered participants have an option to attend another area event, or to a receive a full refund.
  • Lodging/Accomodations are not included with any seminar or course event. Those travelling from a distance and need overnight or weekend lodging, should contact the host facility or other motel/hotel directly. If the event is held at a hotel meeting facility, that hotel has guaranteed their lowest rate available to seminar/course attendees.
  • Your privacy is very important to us. All information received from you is used for internal use only. Personal information is never shared or released to any third parties, unless part of making positive arrangements for this event.

    		•