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FLORIDA BAPTIST CONVENTION

Please enroll me in the "Who AM I? Course.

NAME: Gender: M F

ADDRESS:

CITY: STATE:

Zip Code: EMAIL:

Telephone: Cell:

Why do you desire to take the "Who Am I? course?

Age:(optional) Highest level of Education:

Occupation: Religious Affiliation:

MTH: DAY: YR:

Note: Once you are enrolled in the E-Course you will receive instructions, which will allow you access to the course.

Complete each Part within 3 months and the complete course within 12 months. You will be assigned a Student Advisor, who will contact you after enrollment.