Alzheimer's Disease and Dementia Care Seminar Sign Up Form
Name
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First Name
Last Name
Email of Person Taking the Course
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Address
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Street Address
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City
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Certification/License Type
Ex: RN, LPN, CMA, CNA, MSW
Certification/License Number (if applicable)
Will you need CEUs for taking this course?
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YES
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Course Dates You Are Signing Up For
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Please Select
April 13-14 9:00 AM-1:00 PM
April 15-16 9:00 AM-1:00 PM
April 20-21 9:00 AM-1:00 PM
April 22-23 9:00 AM-1:00 PM
April 27-28 9:00 AM-1:00 PM
April 29-30 9:00 AM-1:00 PM
May4-5 9:00 AM-1:00 PM
Certification fee is separate and is $180 to become certified.
*
I understand
CEUs are a separate fee and will be $49
*
I understand
For the virtual course, I am required to provide my own laptop or netbook and have high speed internet to access the class. I also understand that I am required to have a working camera and that I will need to appear on camera for the duration of the course in order to receive full credit.
*
I understand
I understand that an e-book will be provided as my student handbook in PDF form and that I will have a way to access it during the class.
*
I understand
There is a $100 cancellation fee if I cancel my registration.
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I understand
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Alzheimer's disease and dementia care seminar
Alsheimer's Disease and Dementia Care Seminar
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