Register Today Mr.Miss.Mrs.Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Work PhoneHome Phone*Mobile PhoneEmail* How Did You Hear About Our Program?Your Church Name?Role/Title in Work or Ministry? The Leadership certificate actual cost is $3,500. Currently, we offer up to $3,000 in a scholarship for all students. Set Registration FeePlease enter a value between 500 and 3500.Registration Fee Price: $0.00 Payment Schedule*Pay the full amount todayPay half now, remainder in six months10 equal monthly payments*To finalize payment, please fill out all PayPal profile information on the following pagePayment Amount (2 equal payments) Price: $0.00 Payment Amount (10 equal monthly payments) Price: $0.00 Authorization and Commitment* I agree/understand: that all the information provided is accurate and complete, authorize Inspire Women to initiate charges to my PayPal account as indicated above, and will not hold Inspire Women responsible for any Bank Fees associated with these payments. I promise to contact Inspire Women if there are any status changes to this account while charges are still due. PhoneThis field is for validation purposes and should be left unchanged. For more information email email@example.com or call (713) 521–0690.