DHEC Medication Management (32-hour) Refresher Course

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Please upload a picture of your government issued picture ID ( drivers license or passport)* This field is required.
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When does your Virginia Board of Nursing Medication Aide License Expire?* This field is required.
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Is someone else using their credit card to register the student for class? If so, please provide credit card owners First and Last Name, Address and Phone Number. If not, please write N/A* This field is required.
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Cardholder IDIn an effort to protect against fraud, If cardholder is not the student, please upload cardholders drivers license.
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Please read and sign- By signing this contract, you agree that all information provided is true, accurate, and complete. You agree to the payment terms of this contract. You agree to all terms of this agreement, including, but not limited to, the Electronic payment authorization and recurring charges authorization(if you have elected to pay by recurring electronic funds transfers) when you sign this agreement. By signing this agreement, you acknowledge you are the cardholder or have permission to use the credit/debit card used at the time of registration. If you are a no-call no-show , you will not be eligible for a refund. PLEASE SIGN YOUR FULL NAME* This field is required.
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Medication Aide (68-hour) Refresher Course
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