Training Application Form

Training Course Signup

Participant Registration Form
Referred Agency Name if none N/A in subject line
Participant

First NameLast Name
Course of Interest
High School or College attended City and State Zip Code
E-mail*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Payment
Course List*
prevnext( X )
Coding
per person this includes CPR

$2,000.00



Billing
per person this includes CPR

$1,800.00



Billing, Coding, and Administration
per person this includes CPR

$4,500.00 Quantity



Medical Office Assistant
per person teaches medical terminology and insurance, record-keeping scheduling, and CPR CNA 1

$1,900.00 Quantity



Administration $1500.00
per person teaches you overseeing the front office, greeting guess taking calls, making calls, posting payments AR paying vendors and CPR, CNA 1

$1,500.00 Quantity



RegistrationCoding • Registration for the coding exam
per person refundable if the participant declines the exam. (only 20 participants will be eligible at a time to take this course)

$150.00 Quantity



Registration Billing • Registration for the billing exam
per person refundable if the participant declines the exam. (40 participants will be eligible to take this course)

$150.00 Quantity



Registration for the Medical Office and Assistant Administration Office Support exam
per person (only 5 participants from both programs will be eligible at a time to take this course)

$125.00 Quantity



Exams Coding
per person, this includes a membership for 1 year with AMBA

$300.00 Quantity



Exams Billing
per person, this includes a membership for 1 year with AMBA

$175.00 Quantity



Exams Administration and Medical Office
per person, this includes a membership for 1 year with AMBA

$150.00 Quantity



CSP registration/Orientation and Intake
per person full 4 hours going over the program, paper onboarding, Bio background, and training courses.

$100.00 Quantity



Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Training Course Signup

Payment