Coventry Diocesan Training Partnership
BCDM Module Pool Registration
Welcome to the registration form for the Bishop's Certificate of Discipleship and Mission.  Please complete all questions as accurately as possible.
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Which module are you registering for?

The same modules are sometimes available on different dates; please ensure you choose the correct option.

 
Please complete your personal details.

 
First name

 
Surname

 
Address line 1

 
Address line 2

 
Address line 3

 
Postcode

 
Landline telephone

 
Mobile

 
Please select your age.


 
Please give details of your parish.

 
Parish

 
Incumbent's name

 
Incumbent's email address

 
The cost of each module is £25.  Please use the questions below to make this payment.  Thank you.

Groups of three or more from the same parish receive a 20% discount and pay £20 each.  If you are coming as a group of more than three from your parish, please omit this payment section and go to https://coventrydtp.typeform.com/to/Q3V1qQ where you can find a separate form to make your payment.

If the module is taking place at your parish church you can attend for free; please scroll down to omit this section.

If you are unable to pay online, please bring a cheque made payable to Coventry DBF or cash to the first session.
 
Please enter your Credit or Debit Card number:

 
The CVC number:

(3 or 4 digit security number on the back of your card)
 
The name on your card:

 
Your card's expiry month:


 
Your card's expiry year:


 
Do you have any special requirements (e.g. wheelchair access)?

 
How did you find out about this module?


 
Thank you for registering for this course.  We will be in touch soon with further details.  Please select 'Submit' below.

Thank you for registering.
Diocese of Coventry