PBS Application Form

Were you introduced by a friend? * YesNo

Name of your friend: *

Choose the material you would like to receive: * I would like a FREE Kid's Introductory Pack
I would like a FREE Adult Study Course

Full Name: *

Date of Birth *

Do you have a Bible? (Ages 10 & over only) * YesNo

A Gospel of Luke will be sent to help you do your first four sets of lessons.

Address: *

City: *

Country:

State: *

Province: *

Postal/Zip Code: *

Telephone No.:

( )

Do you have additional family members who like to register with PBS? YesNo

Choose the material this family member would like to receive: * I would like a FREE Kid’s Introductory Pack
I would like a FREE Adult Study Course

Full Name: *

Date of Birth *

How did you hear about us?

Other *