State Government Registration

state Government Training registration form
Agency Information
As an alternative to this online registration form, click here to download and use the electronic version of our registration form. (Printable & Savable)
Agency Name
Address
City, State, Zip
Your Name
Your Phone
Your E-mail
Training Liaison Name
Training Liaison Phone
Training Liaison E-mail

Student Enrollments
Is this an Enrollment Retake?
Student 1
Name
E-mail
Course Name
Course Level (if applicable)
Date
Time
Location
Price (Click Here if Unsure of Price)


Student 2
Name
E-mail
Course Name
Course Level (if applicable)
Date
Time
Location
Price (Click Here if Unsure of Price)

Student 3

Name
E-mail
Course Name
Course Level (if applicable)
Date
Time
Location
Price (Click Here if Unsure of Price)

Total Price

Additional Registration Information

Payment Information (Select Payment Method)
Pro Card
Type of Card
Card number
Name on card
Expiration Date
Last 3 digits on back
Additional Pro Card Information
Address to Mail Paid Receipt:
Agency Name
Street Address
City, State, Zip
Attention

Invoice
Agency Name
Billing Street Address
Billing City, State, Zip
Individual to Invoice
Purchase Order Number
Additional Invoicing Information
Invoice will be snail mailed out with roster
Payment is due 15 days from the enrolled class date(s)

Cancellation Policy
If you cancel or re-schedule a class, you must do so at least three days before the course for desktop application courses or ten days before the course for technical courses to receive full credit or refund. If you cancel or re-schedule within the 3 or 10 day periods, you will be charged for the course. However, you will be allowed to take the class, on a space available basis, the next time that it is offered at no additional charge. Please note that courses may be added, deleted, or rescheduled based on demand or circumstances beyond our control.

I have read and agree to the cancellation policy stated above.

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Please only click the Send Registration button once, it may cause a duplicate registration.

Thank you!

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Agency Information