| |
CE Course Registration
 | Mail to:
 | American Continuing Education Inc. |
| P.O. Box 17980 |
| St-Paul, MN 55117 |
|
| To register, provide the following information:
| Name |
| License number |
| Address |
| Telephone and fax numbers |
| E-mail address |
| Course title(s) |
| Seminar date(s) or self-study |
| Payment method |
| Amount $ |
|
| If paying by credit card, provide:
| VISA or MasterCard (indicate which one) |
| Card number |
| Expiration date |
| Card holder's billing address |
|
| If paying by check,
| Make check payable to American
Continuing Education, Inc. |
|
Confirmation will be mailed 2 weeks prior to the seminar, and will include a receipt, directions
and schedule.
|
