Palm Springs Registration Registration for the Palm Springs Bible School Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Phone*Home Ecclesia Room Request King Bed Two Queen Beds Triple Occupancy (Roll-Away Bed) Handicap Accessible Close to Meeting Hall Ground Floor Poolside - ($240 Surcharge per Room) Would you like to upgrade to a Poolside Room? No Yes - $240.00 Additional Would you like to add Additional Nights BEFORE the Bible School? No 1 Night Before for $120.00 2 Nights Before for $240.00 3 Nights Before for $360.00 Would you like to add Additional Nights AFTER the Bible School? No 1 Night After for $120.00 2 Nights After for $240.00 3 Nights After for $360.00 If you are sharing a room with someone else, please let us know who: Notes or Special Requests How Many People are you Registering?- PLEASE SELECT -1234 First Person's Name* First Last Email Address* Gender* Male Female Baptism Status* Brother Sister Not Baptized Age*- PLEASE SELECT -0-1920-3940-5455-70Over 70Tuition*- PLEASE SELECT -Adult - $480.003 Adults per Room - $400.004 Adults per Room - $360.00Single Occupant - $780.00Daily Visitor - Free 2nd Person's Name* First Last Email Address (If Different) Gender* Male Female Baptism Status* Brother Sister Unbaptized Age*- PLEASE SELECT -0-1920-3940-5455-70Over 70Tuition*- PLEASE SELECT -Adult - $480.003 Adults per Room - $400.004 Adults per Room - $360.00Single Occupant - $780.00Daily Visitor - Free 3rd Person's Name* First Last Email (If Different) Gender* Male Female Baptism Status* Brother Sister Unbaptized Age*- PLEASE SELECT -0-1920-3940-5455-70Over 70Tuition*- PLEASE SELECT -Adult - $480.003 Adults per Room - $400.004 Adults per Room - $360.00Single Occupant - $780.00Daily Visitor - Free 4th Person's Name* First Last Email Address (If Different) Gender* Male Female Baptism Status* Brother Sister Unbaptized Age*- PLEASE SELECT -0-1920-3940-5455-70Over 70Tuition*- PLEASE SELECT -Adult - $480.003 Adults per Room - $400.004 Adults per Room - $360.00Single Occupant - $780.00Daily Visitor - Free Total Tuition Cost $0.00 Which Payment Plan would you like?* 2 Pay - Half Now and Half on February 1st 4 Pay - 1/4 Due Nov, Dec, Jan & Feb How would you like to pay? (There are NO FEES on any Payment)* Credit Card Automatic Check Withdrawal PayPal Mail in a Check
