Alcohol Class Registration Form

Class Registration Form

Please fill out the registration form completely. Registration is NOT complete without a payment.
STUDENT INFORMATION:

Please enter information below for the registered student (if registering for individual classes). We send out class information by email so it is important to leave a valid email address.

If you are registering for a Private Group Class or if you have multiple students to register, you will see the option to input additional student information. Please make sure all student information is filled out completely.
I have a location for the training: *

Yes No If yes, please include address below:
Address for training:
I want to register a group (2 or more students) *

Yes No
Name of person Registering *

First Name Last Name
Student Email (for class reminders and information) *
example@example.com
Contact Phone Number (we must have this to be able to reach out if we need to regarding the class!) *

Area Code Phone Number
Where Should We Ship Study Materials? *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
I have additional student information:

YES NO
Please list all additional student names and email addresses in the box below. If materials must be shipped separately, please indicate that as well and we will be in contact. You may also use this box if you have registered for an Exam Only - please indicate the class you wish to take the Exam at.

My Products

Alcohol Training This is a 4 hour course with the proctored exam.

$ 100.00 Quantity

Total

$ 0.00