as you would like it to appear on the Certificate, including "RN", "MD", "CST" etc.
    (additional students - for groups - 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 "LaserTraining.org" in your Spam folder.
Must include Area Code & Phone # for U.S. #'s
Use Format 5554441212 - No Hypens, Spaces or Dots
Remarks? or
Requests?

Name & "CORRECT"
Emails of
Additional
Students
* Payment Method:
*Enter either Purchase Order # or Credit Card Info
Payment must be received PRIOR to the webinar to gain 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 secure 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
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- Prepay or group discounts will be applied when invoicing or charging your credit card. These charges are manually processed by the office so your card will not be charged at the regular $995 rate if discounts apply.
- Prepay 20 days or more in advance is $100 off each registrant.
- Groups of 2-3 are discounted 15% for the number of people.
- Groups of 4-7 are priced at $2500 flat fee, and then $395 each for registrants past 7 which you
   can add at any time.
Additional Students for the Webinar:  Please list their names as they should appear on Certificates in the box below, and a unique email . You can also call or email our office to add later. Make sure the email address is CORRECT.
For groups at the flat rate of $2500 only one login will be issued and is intended to project the webinar to that entire group in the same location.
You can always CALL our office at 614.883.1739, or Greg Absten's cell phone at 305.849.0285 at any time for changes or ask questions.
This is the person on-site for groups that will be our contact to provide the login information, ensure they have the internet connection and projection equipment setup, and who will manage the sign-in sheet for all attendees getting Certificates. We'll send instruction to them.
Electronic Registration form - WEBINAR LASER SAFETY OFFICER
(use the separate form for in-person attendance)

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.
These are run as hybrid meetings - presentation to live audience and remote Webinar attendees.
Course Manual and Slide Handouts will be sent electronically to registrants upon payment.
Schedule and directions for logging in will also be sent prior to the program.