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Last Name : |
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Address 1 : |
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Address 2 : |
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City : |
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State : |
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Post/Zip Code : |
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Work Phone : |
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Home Phone : |
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Fax : |
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E-mail : |
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Credit Card or Check Guarantee:
A credit card or check is required to guarantee and confirm all course registrations.
Please note that registrations are not guaranteed until processing of your check or
your credit card. An email confirmation will be sent along with a confirmation number
confirming the registration within 48 hours of the online booking |
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Course Tuition : |
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$1300 by September 7th - $1350 September 7th and beyond
SCCEP Member |
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Pay By Check : |
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click here to pay by check (Place held for 7 days) |
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Card Type : |
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CC Number : |
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CC Exp. Date : |
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* (mm/yy) |
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Name : |
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* As it appears on Credit Card |
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Please Enter Code : |
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* (enter characters listed in blue box) |
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Additional Notes or Request |
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* Indicates mandatory fields
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