*required

*First Name:

*Last Name:

If you are using a company card or other account holder's card not in your name, please include the name on the card here to ensure that your registration is properly processed.

Cardholder Name:

*Address:

*City:

*State:

*Zip:

*County:

*Phone: ###-###-####

*Email:

*Language (English, Spanish, Simplified Chinese):

*Employer: (company, school, self-employed, personal interest)

Employer's Address:

Employer's City:

Employer's State:

Employer's Zip:

After pressing submit you will be taken to PayPal where you can pay the $85 course fee. No PayPal account is required. Your class registration is not complete until you make payment

If you have questions about the online registration email Beth