Enrollment Form

Basic Training for Church Security Team Members

Print name as you want it on your certificate______________________________________________

Street address_________________________________City_________________________________

State__________________Zip Code__________________email_____________________________

Home Church____________________________________Location___________________________

Telephone#_______________________________



Instructions

1. Mail this application along with check or cash in the amount of $180.00 to Centurion Bible College, 3100 17th
Ave, Vienna, 26105.

2. Students must be present both days in order to receive their certificate.  Participation in the shooting
simulator is optional.

3. There are no tuition refunds, however, you can give your place to another student in the event that your
plans change.



Do you wish to participate in the shooting simulator?        Yes_____            No_____

If so, do you prefer going to the simulator at 4:45 PM on February 16th or March 2nd?______________

Note: We may or may not be able to give you your preferred date, depending upon demand.  We will give first
choice to the earliest applicants.

Be Prompt!  Class starts at 9:00 AM and there is much to cover.