Clinical Research Training Program
Enrollment / Installment Form
Name
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First Name
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Phone Number
Email
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example@example.com
Medical School or Hospital Name & Address
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Street Address, City, State, Country
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Billing Address
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Street Address, City, State, Country
City, State/Province
State / Province
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Specialty of Interest (First and Second Preferences)
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Program Selection
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Clinical Research Training Program
Payment Mode
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US Bank to Bank Zelle (Ask Organization's Bank details)
Debit / Credit Card (Notify and pre-approve this national/international transaction from your credit card company in order to avoid "Decline of Transaction")
Image of "US Bank to Bank Zelle" (Ask us for the bank receipt to upload here)
Debit/Credit Card Users
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Enrollment -
$
300.00
The one-time non-refundable enrollment fee will be utilized toward the cost of the review material, technology, software, and 5-year access to the Google Classroom & study material.
Installment 1 -
$
1,500.00
Due Date: 30 days prior to the start date
Installment 2 -
$
1,500.00
Due Date: 1-month from Installment 1
Late Fees - Per Installment -
$
25.00
Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Debit/Credit Card
I have discussed the program details with Research Update Team. I agree to pay the FULL fees. (Non-refundable)
*
Yes
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