Diocesan Institute Registration - Formstack

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Diocesan Institute - Online Registration

(* Indicates a required field)

Name*

Prefix (optional)

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Email*

Parish/School, City*

Other Parish/School

Are you a Catechist?:

Yes No

Are you a School Teacher?:

Yes No

Other (please specify):

Winter/Spring 2020

Course Selection Instructions:

If you select a pre-recorded webinar, the course and access instructions will be e-mailed to you.

Once you submit your online registration, you should receive an e-mail confirmation that your registration has been submitted successfully.

If you wish to register within one week of the start date for a “LIVE” course, please call (717) 657-4804, ext. 229 to confirm the status of the course before submitting registration and payment.

For information about registering for the Introduction to the Church course or the Teaching Methodology – Parts 1 and 2 course, please contact Ryan Bolster at 717-657-4804, ext. 225.

On the menu below, please mark the course (s) for which you wish to register.

Course ID/Start Date/Location

I12 Introduction to Prayer - Apr. 15, 22, 29, May 6, 13 (6:30 - 8:30 p.m.) Diocesan Center, Harrisburg - $25

Payment Method*

(please enter method of payment)

Total Charge* $

(this amount will be charged to your credit card)

Credit Card*

Visa and Mastercard gladly accepted.

HCAS REQUEST FOR PAYMENT

Account Number*

(5XXXX)

Fund Number*

(XXXX)

Cost Center*

(XXXX)

Physical Location*

(XXXX)

Program*

(XXXX)

Funding Source*

(XXXX)

Event*

(XXXX)

Organization*

(XXXX)

Department*

(XXXX)

Amount to Charge* $

Approved by*

Check Number

Check Amount $

_________________

*All refunds will be provided as a credit to the credit card used at the time of donation/purchase within 30 days of original transaction.

Confirmation Page

Diocesan Institute Registration

PLEASE REVIEW YOUR INFORMATION AND HIT SUBMIT AT THE BOTTOM OF THIS PAGE TO COMPLETE YOUR SUBMISSION.

Name: {$15585736 Name}

Address: {$15585737 Address}

Phone: {$15585738 Phone} Email: {$15585739 Email}

Parish/School: {$55483508 Parish/School, City} {$55483912 Other Parish/School}

Catechist? {$15585741 Are you a Catechist?: } Teacher? {$15585742 Are you a School Teacher?: }

Other: {$15585743 Other (please specify): }

Course Selections:

{$32472226 Course ID - Pre-recorded Webinars}

Payment Information:

Payment Method: {$15585746 Payment Method}

Total Credit Card Charge: {$15585747 Total Charge}

Account Number: {$34936674 Parish/School Account Number}

Fund Number: {$34936675 Fund Number}

Cost Center: {$34936676 Cost Center}

Physical Location: {$34936677 Physical Location}

Program: {$34936678 Program}

Funding Source: {$34936696 Funding Source}

Event: {$44377180 Event}

Organization: {$44377175 Organization}

Department: {$44377174 Department}

Amount to Charge: {$44377190 Amount to Charge}

Approved by: {$34936698 Approved by}