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Online Continuing education Courses

Electronic Application for COURSE REGISTRATION

Personal Information
Full Name:
Email:
Mailing Address:
City:
State:
Zip:
Phone (Area code - Number):
COURSE SELECTION
Course Title:
Course Code:
Cost of Course:
Today's Date:
Are you Currently Certified by AIHCP? Yes No

This registration form must be completed fully to properly enroll into a CEU Online Course. Upon completion, please be sure to click the "submit" button at the bottom of this form.

Please Provide the Following Information
Organization or Certifying Body you are currently certified by: (If you hold a current certification)
Which Pre-requisite(s) do you currently meet for entering our Education/Certification Programs?

Payment Information

We accept the following major credit cards: Visa, Master Card, And American Express. If you would like to postal mail your CEU Course registration, DO NOT complete and submit this electronic form. Rather, please access the link above for "PRINTABLE REGISTRATION FORM." You may print out this registration form and postal mail your registration and payment. By postal mail, you may pay by check, money order (payable to: AIHCP) or by providing credit card information on the registration form. If postal mailing in your registration and payment, you may send to: AIHCP, 2400 Niles-Cortland Rd. SE, Suite # 3, Warren, Ohio 44484.

NOTE: if you are paying for a CE Course by credit card, after clicking the submit button below, you will directed to a page with a link to use our secure online credit card server. You will receive an e-mail receipt of your online payment.

Agreement

I, the undersigned, verify that this application is complete, and to the best of my knowledge, all information provided is factual and true. I understand that failure to provide the needed information and required documentation could likely lead to delays in the processing of this application.

By clicking the "submit" bottom below, I acknowledge that I understand that the course or courses I am registering for are continuing education courses and that upon successful completion of the course (s) I will be awarded and receive a CEU certificate with the corresponding hours of awarded education. I understand that AIHCP is not a school, and that the course(s) I am registering for are neither college courses nor are they intended for any type of transfer credits to any schools or colleges/universities and will not be accepted toward any type of college degrees. I further understand that the cost of course tuition does not include any required textbook and I am responsible for securing my own textbook. I further understand that I have two full years from the date of official enrollment into a course, to complete the course.

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2400 Niles-Cortland Rd. S.E. Suite #4, Warren, Ohio 44484
Tel: 330-652-7776 • Fax: 330-652-7575

© 2006 American Institute of Health Care Professionals