C O U R S E   R E G I S T R A T I O N   F O R M

NOTE: We cannot currently take course registrations over the web. After filling out this form, please fax or mail it to us at the address listed at the bottom of the page. THIS FORM DOES NOT STORE NOR TRANSMIT ANY INFORMATION. YOU MUST MAIL OR FAX THIS FORM TO US. Don't forget to sign the form if paying by credit card.

A $50.00 non-refundable deposit must accompany each registration form. The balance of the tuition is due 2 weeks prior to the starting date of the course. Balance can be transferred or refunded with 2 weeks written notice; notice received after that time is subject to only a 50% transfer or refund less the deposit. If cancellation is received less than 72 hours before the start of the course, no monies will be refunded, but may be transferred to another course of the students choosing. No refunds will be issued after course begins.

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Make Checks Payable To:
ADVANCES IN CLINICAL EDUCATION
17675 SW Farmington Road #182
Aloha, OR 97007
1-503-642-4432
FAX 1-503-848-6384

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