CCMA Registration Form
Fill out the form carefully for registration
Student Name
*
First Name
Middle Name
Last Name
Birth Date
*
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Year
Gender
*
Please Select
Male
Female
N/A
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student E-mail
*
example@example.com
Mobile Number
*
Phone Number
*
Current Employer
*
Work Number
*
My Products
*
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CCMA Deposit
$
500.00
CCMA Full Course
$
2,000.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Additional Comments
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