Course Registration Form - ITS Academy NY

ATTENDEE REGISTRATION FORM

Fill out the form carefully for registration
Attendee Name*

First NameLast Name
License Type*
Company Name*
Gender*
Mobile Number*
Format: (000) 000-0000.
Attendee Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PAYMENT DETAILS
Training Courses*
Preferred Training Date*

MonthDayYear
Scholarship Code
Check the available dates for the training in our Calendar of Courses

**Please do not select split payments unless this was previously discussed with your advisor.
All tuition must be paid in full 1 week prior to your first course**
Full PaymentPayment Plan
How many installment payments did you discuss with your advisor? (Max 3)*

If Paying in Full: Please Enter FULL Amount | If Paying in Installments: Please Enter Installment Amount (Full Price Divided by Installments)*

USDCourse Price

Which advisor has been assisting you?
Additional Comments
635 MADISON AVE, STE 1400 NEW YORK, NY 10022

Tel: (646) 760-3618

INFO@ITSACADEMYNYC.COM
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ATTENDEE REGISTRATION FORM