This form will complete the registration process and securely accept your payment. Registering takes less than 3 minutes. All fields are required
Okay, let's register!
Hey! A payment field in this typeform can’t load in your browser. To pay and submit your responses, please view this typeform in one of these browsers.
What is your first name? *

What is your last name? *

Do you understand that you need to be online paying attention for the duration of the course? (We are required to ask this question) *

The Massachusetts Division of Professional Licensure requires that you are present for the two live day sessions. The remaining hours will be completed via pre-recorded video. If you will not be able to attend the two day long sessions, you will not be eligible to receive a certificate for completing the course *

Sorry, the state makes these rules, not us.

Which upcoming course would you like to register for? *

All full day live sessions are held on Saturday and Sunday.

Please give us your telephone number so we can better understand and try to accommodate your situation. *

Is {{answer_55513645}} {{answer_55513648}} the name you want to appear on your certificate of completion? *

Please enter the full name you would like to appear on your certificate. *

Your credit card will be charged {{var_price}} today. Please enter your credit or debit card information below. *

Sorry, your browser doesn’t support payments
What is your current mailing address? *

(insert complete address)
What is your telephone number? *

(if we have any questions or need to contact you)
You have just registered for the course and will receive a confirmation email with further instructions to your inbox shortly.
Back to Keep Me Certified
Powered by Typeform
Powered by Typeform