Credit Card Payment Registration:
This registration form is for payment through Paypal or Visa, Mastercard, Discover or American Express. When selecting the Submit button, you will be directed to the secure Leotta, LLC. Paypal electronic payment page where you can pay for this course using Paypal or a major credit card. Once registration is received, you will receive an electronic receipt via email which confirms your registration. If you wish to pay via check or purchase order, please close this window and select "Purchase Order and Check Registration" button on the course description page.
IF YOU WISH TO PRINT A COPY OF THIS FORM FOR YOUR OWN RECORDS, PLEASE SELECT "PRINT FORM" PRIOR TO SUBMITTING YOUR REGISTRATION.