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

Company Affiliation
(if applicable)

Course You Are Registering For:

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.

Payment Method

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 our online course catalog. If you choose to pay by cashier's check, money order, or cash you will receive a link to our course catalog via email.

All of our credit card payments are processed securely through

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
Company Affiliation (if applicable)
Course You Are Registering For:
Name of person paying if other than yourself:
Type of Study: