Training = Healthcare Seminar

Full Name*

First NameLast Name

E-mail*

example@example.com

Phone Number*

Number of people attending*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Payments are processed through PayPal. You may pay using an existing PayPal account, or any major credit card / debit card.

I hereby agree to following payment schedule (please select one):

Pay in FullEarly Bird Payment Plan: $174.50 to be charged now and $174.50 to be charged on May 5, 2023 (per person)Student Payment Plan: $174.50 to be charged now and $174.50 to be charged on May 5, 2023 (per person)Regular Pricing Payment Plan: $199.50 to be charge now and $199.50 to be charged on May 5, 2023 (per person)

Signature

Clear

My Products

Early Bird - Full Price

$349.00 Quantity

Early Bird - Payment Plan$174.50 due now, $174.50 will be charged 2 weeks prior to course

$174.50 Quantity

Student - Full Price

$349.00 Quantity

Student - Payment Plan$174.50 due now, $174.50 will be charged 2 weeks prior to course

$174.50 Quantity

Full Price

$399.00 Quantity

Full Price - Payment Plan $199.50 due now, $199.50 will be charged 2 weeks prior to course

$199.50 Quantity

Total

$0.00

loading smart payment buttons...

Training = Healthcare Seminar Registration: May 20-21