Please print out this page and mail it to
Koinonia Bible College
5049 Ehret Road • Marrero LA 70072-5327
...or fax it to 504/328-1817.
If paying by Visa or Mastercard, fill out the information at right. If paying by check, please enclose the check. Make your check payable to "Koinonia Bible College."
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List the name of each course you want to take. Lectures will be provided on CD, unless you specify audiocassette.
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Add up your fees:
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Course fee: $99.95 per course.
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Shipping and handling: $5 per course.
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Required for course on Revelation: 8-tape series on the prophecies of Daniel, with workbook: $24.95, plus $2.00 shipping and handling.
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Total
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First name, middle initial, last name
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Street address, city, state, ZIP code
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Daytime telephone
including area code
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Evening telephone
including area code
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E-mail address
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Date of birth
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Social security number
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Male or female?
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If paying by credit card, complete the following:
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Type of card
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____Mastercard ____Visa
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Name on the card
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Card number
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3-digit code
from back of card
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Expiration date
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Authorization signature
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