Christian Science Nurse or Nurse's Aide Listing Placement Form

Annual fee: $50

Questions?
eMail us or call 602-635-1987

Use this online form to place your ad as a Christian Science Nurse or Nurse's Aide. Once you have completed the form, you will be taken to a page where you may pay the $50/year fee online by credit card or you will be given the mailing address to pay by check.

All ads must be prepaid before they can run. [You will be taken to a payment page once this form is completed. Payment may be made by check or you may make a credit card payment thru our secure online PAYPAL processing link.]

Contact Information (for our use):

First and Last Name**

eMail Address**

Re-enter eMail Address**

Submitter phone number with area code**

Submitter mailing address (for billing only)**

Are you a member of The Mother Church. **
(for office use only)
Yes, I am a member of The Mother Church
No, I am NOT a member of The Mother Church

Have you had Christian Science Primary Class Instruction? **
(for office use only)
Yes, I have had Christian Science Primary Class Instruction
No, I have NOT had Christian Science Primary Class Instruction
If YES, who was your Christian Science Teacher?
(for office use only)

Special instructions/questions

Information which will appear in your listing:

How do you want your name to appear in the ad?**

Are you a member of The Mother Church?**
yes no
TMC membership is not required, but will be indicated

We accept listings of Christian Science Nurses who are Journal-listed as well as non-Journal-listed full and part time Christian Science Nurses and Nurse's Aides. People working toward their Journal-listing may also wish to use this advertising opportunity to help them in establishing their practice. Please chose your classification below. They will appear in your practitioner listing**
Full time, Journal-listed Nurse (JL-FT)
Part time, Journal-listed Nurse (JL-PT)
Full time, not listed in the Journal (FT)
Part time, not listed in the Journal (PT)
Nurse's Aide (Aide)

Address listed in ad including postal code (optional)

City/State/Country**

Telephone Number (including area code)

Mobile Phone Number (including area code)
(optional)

Fax number - optional (including area code)
(optional)

eMail address (HIGHLY RECOMMENDED) - if you have not opted for a free cspractitioners.com address

Web site - Do you have a personal web site for your practice? We're happy to list it. (optional - no extra charge)

Blog site - Do you have a personal blog site (what is a blog) for your practice? We're happy to list it. (optional - no extra charge)

Text messaging - (optional - no extra charge)

Skype ID - (optional - no extra charge)
[what is Skype?]

Introduction - You are allowed a 150 character (letters and spaces) introduction printed with your listing (optional)

Photo - you may eMail us a photo for your listing (optional - no extra charge) The photo will be displayed at 80 x 120 pixels. We can size and crop it for you here. If you need to mail us a photo, send it to Prayerful Living Publishing, PO Box 74248, Phoenix, AZ 85087

Yes, I will be eMailing/mailing a photo for inclusion in my listing.

** required fields