as you would like it to appear on the Certificate, including "RN", "MD", "CST" etc.
    (additional students will be listed in a field lower down on this form)
Confirmation, and any course materials and online authorizations will be sent electronically via email to this address, in addition to any course status updates.
Watch for emails from "Trakstar" in your Spam folder.
Must include Area Code & Phone # for U.S. #'s
Use Format 5554441212 - No Hypens, Spaces or Dots
CHECK THE BOX at left if this is for ADDITIONAL STUDENTS in your EXISTING package, and not an original order. CLICK HERE for Instructions, if needed, on adding those additional students.
If you select the 2+ persons option, enter names & emails in the Remarks box below. You can also just call us later with the names & emails. If you buy the one person program, you have 30 Days to add the second person for the discounted price.
Additional Students for the Programs:  Please list their names as they should appear on Certificates in the box below, and a unique email to set them up. You can also call our office to add later. Make sure the email address is CORRECT. Up to 5 total additional are included in the "2+" Course Selections. An additional fee of $125 pp will apply past the initial 2 persons. You can add these people at any time in the future - no time limit.
Remarks? or
Requests?

Name & "CORRECT"
Emails of
Additional
Students
* Payment Method:
*Enter either Purchase Order # or Credit Card Info
No payment information is required for the "FREE PREVIEWS"
Student will have access to the online program after payment has been received for the Purchase Order. Otherwise please use a Credit Card for quicker access.
mm/yy
3 or 4 Digit
If I am paying by credit card, I hereby authorize charges to my card for the item(s) ordered.
Note - these CC charges are manually processed in our office and will not automatically charge your card from this submission form.
By placing this order and clicking the SUBMIT button below, you acknowledge that you have read the REFUND POLICY and agree with its terms.

Privacy Policy
Please type the txt into the box. For new numbers just double click the box
Click for new image
Electronic Registration form - all Home-Study/Online Courses
(use the separate form for in-person seminars)

Once you have registered you will receive an email confirmation and directions within about 1 business day..
Payment must be received prior to starting course.
You'll set up your own password online with the email address you provided below.
Course Manual and Slide Handouts are available as a download from the first slide in the first module of the course. Don't forget to download them.
NOTE: If you prefer to download a PDF Registration form and send back to us. CLICK HERE.
We understand that this form doesn't load correctly in some hospital systems. We think it has something to do with I.T. blocks on some php forms like this but not sure. We prefer that you use this form, but if not just download and use the PDF.