Only one person needs to fill out the registration.  This person will serve as the contact person and person responsible for payment unless other payment plans have been previously worked out. Registering a group or staff requires the submission of all the names taking the training. Only continuing education credit and certificate of completion will be provided to the persons indicated on the registration form. Each group will receive a User ID and each member of the group will receive their own individual passwords.  This is done for statistical purposes and ensure proper identification in receiving the continuing education credits and certificate of completion.

Registration for Individuals, Groups or Staff
 
Your Name:  Degree(s): Age:
Address:  City:  State: 
Zip Code:  Country:  Email Address: 
Day Phone: 
Employee Information
Employer:  Position:
Address:  City:

 State:   

Zip Code: Country:
Number of employees registering for this training 
Please enter the names of each employee who will be viewing this training and indicate interest in CE credits and certification. Please include you name if you are participating

A. Certification  B. CE Credits  C. Both  D. Neither

Name:ABCD Name:ABCD Name:ABCD
Name:ABCD Name:ABCD Name:ABCD
Name:ABCD Name:ABCD Name:ABCD
Name:ABCD Name:ABCD Name:ABCD
Name:ABCD Name:ABCD Name:ABCD
Name:ABCD Name:ABCD Name:ABCD
Name:ABCD Name:ABCD I would like to register more
  We would like to order  Response-Kits  
Payment
Credit card type:  C.C.#:  Expiration date: 
Name as it appears on the Card:     
Billing address if different from above:
Address: City: State:  
Zip: Country:
Training questions
How did you learn about this training?
Log-in
Preferred user I.D.: 
Disclaimer
My check indicates that I have read and agree to the terms of the disclaimer for myself and those named on the registration form.