Registration

Course Registration Form

One Registration Form Per Student

Course Name:

Course Date:

Student Name(Last Name, First Name, Middle Initial):

Company Name:

Company Address:

Company Phone: Fax:

E-mail:

Home Address:

Home Phone: Cell:

E-mail:

Tuition is due three (3) days prior to the first day of class. Checks are made payable to Design For Health Training Center. Please Note: Certificates will not be issued if payment has not been received or an arrangement has not been confirmed by our office. When enrolling for a refresher course, you MUST submit a copy of your previous certificate with this registration form or bring the certificate with you to class.

Credit is issued when there are fewer than 3 people registered 48 hours prior to start date and the class is subject to cancellation. (Student will be automatically moved to next scheduled class) REQUEST for refunds are subject to a $25.00 per course processing fee.

Start Time: All classes will begin at 9:00 AM unless otherwise specified.

Please print and fax a copy of this form

Fax To: (619) 291-4318

Registration

REGISTRATION