College Student Enrichment

Cost: $150 for an individual; $275 for a couple

Room & Board: Provided by EBI

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

What Church do you Attend?

Anyone else attending?*

Spouse's Name

Tuition Cost

Payment Information

All weekend costs are refundable (minus 10% transaction fees) until one month before the weekend. A 50% refund will be given until two weeks before the weekend. No refunds will be given after two weeks prior to the weekend.

Select the Paypal option to pay online via PayPal or Debit/Credit Card. After clicking the "Submit" button, you will be redirected to Paypal's website to complete payment.

Important: Registration will not be submitted until a payment option is selected. If you are not prepared to pay online now, please select "mail check" option below. Please send a check at your earliest convenience. Thank you!

Payment Options*

Credit CardMail Check

Make check payable to:

Elnora Bible Institute

101 S State Road 58

Elnora, IN 47529

Total Cost

Comments

Pay via Credit Card

USD

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country