Course Registration Form

California License #:

Last Name: *

First Name: *

Course You Want to Enroll: *

Organization:

E-Mail: *

Phone Number: *

Fax:

Street Address:

City, Zip code:

Terms of agreement

By clicking this, you agree to accept our policy!

you agree to pay within 24 hours upon successful registration of the courses
you agree to fill out our evaluation form of the courses you will take
you agree to release your evaluation contents to our marketing and governmental agencies
you agree NOT to share your access to the paid courses with other people than your office staff.

Acceptance of agreement: *

Yes, I accept (You must accept the conditions in order to register the course)

If you have any special request or questions, please submit them in the area beloww:

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Course Registration Form

Terms of agreement