Registration Form

Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Acknowledgment that you have either a GED or a High School diploma.
Are you a member of the American Registry of Phlebotomy Technicians?
Do you agree to the following membership criteria: You are actively pursuing phlebotomy certification. You agree to actively pursue self study from scientific journals on a quarterly basis. You agree to support other members and provide helpful information to further education, if requested by another member. You agree that you are not a part nor will not pursue membership of any other competing phlebotomy associations.
Which location and date are you reserving a seat for?
How did you hear about us?
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Full Course

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$894.00 Quantity

Digital Course

The remaining $644 will be collected in person on the day of training prior to the class starting.

$250.00

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Total

PLEASE NOTE that when you make a purchase you will receive an email from Jotform that provides you with a copy of your answers AND an invoice will be attached to that email as a PDF. Please look for that invoice as it has details regarding our process approval and receiving your link for the online curriculum. If for some reason this email went to your spam folder, please mark it as 'not spam' so that it will go to your inbox. Please type "read" if you have "read" and acknowledge these details.
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