Self-Paced EMR Course Registration - Allied Medical Training

Course Options

EMR: Self-Paced

Select Skill Weekend*

Student Information

Full Name*

First Last

Email Address*

Course instructions will be emailed to this address, and it will also become your username to login to the online course.

Enter Email Confirm Email

Phone Number*

Just in case we can't reach you by email.

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And your mailing address?

Street Address Address Line 2 City State ZIP Code

Anything else you'd like us to know?

Payment

Discount Code

Northwestern Health Verification*

I verify that I am currently a student or faculty/staff member of Northwestern Health Sciences University.

Total

$0.00

Payment Method*

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Invoice to a Sponsoring Organization

Did your organization give you a code to enter when registering?*

Organization ID Code*

Name of Organization*

Contact Person at Organization*

First Last

Phone of Contact Person*

Email of Contact Person*

Enter Email Confirm Email

Mailing Address of Organization*

Street Address Address Line 2 City State ZIP Code

Instruction for Submitting Invoice

Enter any specific instructions we should know about submitting an invoice to this organization (for example: what to include in the memo, etc).

Terms & Conditions

Invoice Terms and Conditions*

I understand and agree that the organization above has authorized payment for my course fees, and payment must be received by the due date indicated on the invoice otherwise my course registration will be canceled.

Course Time Commitment*

I understand and agree that at least 30-40 hours of learning is needed to complete the online coursework, and the deadline for finishing the online coursework is one week before Skill Weekend.

Terms and Conditions*

I understand and agree to the TERMS AND CONDITIONS

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Signature of Student

By typing my first and last name below, I verify understanding and agree to the terms and conditions. I also verify that the person completing this form is the student enrolling in the course.