STAR Center | Course Registration

Registration
Personal Information*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Primary Phone*
Please enter a valid phone number.
Email*

Confirmation EmailExample: yourName@company.com
Merchant Mariner Number*
Company Name
Company POC
Course(s) Desired
Select number of courses desired:
Please select between (1-5)
Course #1 Name:
Please type the name of the course #1
Course #1 Start Date:

MonthDayYear
Please select a start date
Course # 1 Total Cost: $
Please enter the total cost for Course # 1
Course #2 Name:
Please type the name of the course #2
Course #2 Start Date:

MonthDayYear
Please select a start date
Course # 2 Total Cost: $
Please enter the total cost for Course # 2
Course #3 Name:
Please type the name of the course #3
Course #3 Start Date:

MonthDayYear
Please select a start date
Course # 3 Total Cost: $
Please enter the total cost for Course # 3
Course #4 Name:
Please type the name of the course #4
Course #4 Start Date:

MonthDayYear
Please select a start date
Course # 4 Total Cost: $
Please enter the total cost for Course # 4
Course #5 Name:
Please type the name of the course #5
Course #5 Start Date:

MonthDayYear
Please select a start date
Course # 5 Total Cost: $
Please enter the total cost for Course # 5
Course(s) Total: $
Total amount for course(s)
ONSITE ACCOMMODATION
Do you require onsite lodging?*

YesNo
Check-In Date:*

MonthDayYear
Date
Check-Out Date:*

MonthDayYear
Date
# Nights:
Number of nights will be automatically calculated once the above dates are selected!
Accommodation Fee @ $210/night + tax: $
Number of nights will be automatically calculated once the above dates are selected!
Will you have guests? (Guest fee applies for guests 12 years and older)*

YesNo
How many guests?*
Please use the - or + sign to add or remove guests!
# of nights guest(s) will stay?*
Please use the - or + sign to add or remove # of nights
Guest Fee(s) @ $86 /night + tax: $
I am tax exempt*

YesNo
Tax on accommodation: $
Accommodation Fee (Tax Exempt): $
Total amount on accommodation without tax!
Accommodation Fee (with Tax): $
Total amount for accommodation, with tax!

TOTAL AMOUNT DUE

Total Due = TUITION + ACCOMMODATION
TOTAL AMOUNT DUE (Tax Exempt): $
Total Amount Due (Tax Exempt)
TOTAL AMOUNT DUE (Tax Non-Exempt): $
Total Amount Due (Tax Non-Exempt)
PAYMENT

It is understood and agreed that confirmation of a slot in the course(s) for which application herein is made may not be final until two (2) weeks prior to the scheduled class start date.
Full payment for tuition shall be made prior to course commencement unless other direct bill arrangements have been made.
Select Payment Method
If paying by credit card, please click on the link below or call us at: 800-942-3220 Ext. 201 or 954-920-3222 Ext. 201 with card details to confirm class slot.
CLICK HERE for secure submission of card information!
Company PO only accepted if approved for Direct Billing.Company credit card required to be on file.
Purchase Order #:
Company or Student?

CompanyStudent (Individual)
AGREEMENT*

I agree to terms & conditions.
Terms & Conditions. Please click here to view STAR Center Payment/Cancellation/Refund policy
COMMENTS
Additional Comments and/or Information
Thank you for your time today!
If you have any questions, please either:

1. E-Mail us at register@star-center.com

2. Call us at 800-942-3220 Ext. 201 or 954-920-3222 Ext. 201

3. Fax us at +1 954 920 3140
You will be able to REVIEW this form before submitting it.
Should be Empty:

Registration

Course(s) Desired

ONSITE ACCOMMODATION

TOTAL AMOUNT DUE

PAYMENT

COMMENTS