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EMR Skill Weekend Transfer
Course Options
Start Date of Your Original Skill Training Class
*
MM slash DD slash YYYY
Available Classes
*
Skill Weekend or Evening Skills
Select New Skill Training Dates
August 2 - 3, 2025
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Alternate Skill Weekend
*
Choose a backup spot in an additional Skill Weekend in case a spot does not open up for you in the waitlisted Skill Week.
Alternate Skill Weekend
Student Information
Full Name
*
First
Last
Email Address
*
Enter Email
Confirm Email
Alternate Email Address
If you have a additional email address, please enter it here.
Enter Email
Confirm Email
Phone Number
*
Anything else you'd like us to know?
Payment
Discount Code
Total
$0.00
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Payment Method (hidden)
Choose Payment Method
Credit or Debit Card
Credit/Debit Card
*
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Exp Month
01
02
03
04
05
06
07
08
09
10
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12
Exp Year
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
Expiration Date
Security Code
Cardholder Name
Agreement & Signature
Online Course Completion Requirement
*
I understand and agree that I will not be allowed to attend my registered Skill Training class if I have not completed and passed the online portion of the course one week before the first day of class.
Refund Policy
*
I understand and agree that there is no refund of Skill Training tuition nor any refund of Skill Training Transfer Fee under any circumstances as documented in the
TERMS AND CONDITIONS
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.
First
Last
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