Atlanta 5-1-26 Registration

Atlanta Live Registration
Office Name*
Office Email*
example@example.com
Office Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Office Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Attendees (May choose UP TO 3 class options PER ATTENDEE)*
Signature of Office Representative*

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Name of Office Representative*

First NameLast Name
Please add the TOTAL amount of classes for your office.

Ex.) If you have 5 people attending the Opioids course and 3 people attending the Ethics course, please go to the “Opioids” option and select “5” on the dropdown menu where it says “quantity,” and go to the “Ethics” option and select “3” on the dropdown menu where it says “quantity”

My Products*

OSHA/HIPAA/Infection Control

4 hours LIVE & 1 hour self study, includes Waterline Instruction

$85.00 Quantity

Ethics & Professionalism

1 hour LIVE & 1 hour self study

$55.00 Quantity

Opioid

1 hour LIVE & 2 hour self study

$55.00 Quantity

Domestic Violence

2 hour LIVE & 1 hour self study

$55.00 Quantity

All

Total of 8 LIVE HOURS & 5 SELF STUDY HOURS

$195.00 Quantity

Total

$0.00

Atlanta Live Registration