Registration Page -

Name

First

Last

Phone

Method in I

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

How did you hear about this program?

Why are you interested in the program?

I understand that the required materials and supplies fee is due at the time of registration. I acknowledge that this fee is non-refundable under any circumstances, including withdrawal, cancellation, failure to attend, or dismissal from the program.

Yes. I agree

Program of choice

Surgical Tech Program Study Materials – $599.00
Phlebotomy – $99.00
Diagnostic Medical Sonography materials – $1,500.00
Medical Assistant study materials – $150.00
Patient Care Technician study materials – $150.00
EKG study materials – $99.00

Payment Method

Card Number

Expiration Date

Security Code

Card Holder Name