top of page

Class Title*

Class Date(s)*

Name of Class Location*


First Name*

Last Name*

My Professional License level that I'm taking this course is for*

Course Options I Want, Comments, Questions, Dietary Restrictions or Requests


Primary Phone (indicate if text msg OK)*

How did you hear about us / this class?*

City, State, Zip

Field Label

*Select from drop-down menu. If you are registering for more than one class or skills session, type additional class titles in "Comments" below.

*Enter date of class, not the date you're completing this form

*Name of building, site, etc.

*If your class has a required text, be sure to order (or rent one from us if available). If class does not have a textbook, select N/A. If you are renting books, enter the address where you want them sent in the Comments box, or follow any other instructions given.

*Will be used for CE document if applicable.

*Will be used for CE document if applicable.

If there are additional course options, such as a meal or activity, list them here. Then confirm when you complete the payment process.

*Email where you will receive class information & updates, and an electronic course completion card in some cases

*Phone you can be contacted if needed. Type in "text" if OK to send text messages. Example: 971-239-4631 text. If not OK, enter phone number only.

Clicking "Send Message" delivers this registration by email. It does NOT secure your place in the class. Please proceed to the Payments page.

bottom of page