Online Course Registration Form

Please provide the following contact information:

 

*Last 5 digits of SS#:

*First Name

Middle Name

*Last Name

Jr./Sr./etc

*Street Address

*City

*State/Province

*Zip/Postal Code

*Home Phone

   (999-999-9999)

Work Phone

   (999-999-9999)

Cell Phone

    (999-999-9999)

Fax Number

   (999-999-9999)

*E-mail

(Existing users provide original email and password.)
*Password
*Confirm password
   

*Course You Are Registering For:

*Payment Method

VisaMastercardAmerican ExpressDiscoverPayPal

Company Affiliation
(if applicable)

(*Required if payment option is 'Agency Billing')

Name of person paying if other than yourself:

Type of Study:

    Comments:

 


Refund, Check, and Course Completion Policy

  • There will be a $25.00 returned check charge on all checks returned.

  • Any refunds will be subject to a 10% administrative fee deducted from the return.

  • There will be no refunds on self-study courses where passwords have been provided - no refunds on books, computer programs, or other material purchased.

  • Each course must be completed in 90 days. All courses begin at the time the self-study material is received. 

Once you submit this form you will be directed to our payment options.  

If you wish to pay by credit card, you will be directed to checkout through paypal.  If you choose to pay by cashier's check, money order, or cash you will receive access to the curriculum through a link sent via email when your payment is processed.

All of our credit card payments are processed securely through PayPal