Student Application Form

Name:
Address:
Home:
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Work:
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Fax:

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Cell:
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E-mail:
S.I.N.
Please send me an application form for:
Full/Part Time
Occasional
Audit
Method of Payment:
Cheque
Credit Card
Credit Card Information
Visa
Mastercard
Amex
Card Number:
Expiry Date:

An income tax receipt for tuition will be issued by E.P.B.C.

Make Cheques payable to: EPBC

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Eastern Pentecostal Bible College
780 Argyle Street
PETERBOROUGH, Ontario K9H 5T2

http://www.epbc.edu