MCS-P Certification Course Registration Page

Please fill in the following form or click here for a .pdf form you can print and mail or fax.

IMPORTANT: After you've filled in the form, click on the "Submit" button at the bottom of the page to send the information. (You should receive a new Page telling you that the information has been sent.) We will not get the information unless you click on the submit button.

For assistance call 1-254-582-7635 or Fax 1-254-582-7653.
(The fields marked with a * are required.)

First name*:
Last Name*:		Have a question about registration? Click to chat with a live person.
Company:
Position/Title:
Address*:
Address:
City*:	State*:	Zip*:
Bus. Phone*:	Home Phone:
Fax:	Email:
Location/Date*:	Click Here Anchorage, AK May 24-28 Dallas, TX June 23-27 Cherry Hill, NJ July/August Decatur,Il August 21 Dallas, TX August 23-27 Sept UpDate Session Sept 27-29 Cherry Hill, NJ Oct/Nov Dallas, TX Nov. 15-19
Course*:	Click Here MCS-P Course and Certification Test MCS-P Course with CP MCS-P Course only  MCS-P Up-Date Session Certification Exam Only Certification Exam Retake
Payment*:	Visa Mastercard American Express Check
Please charge my card:
Name on Card:
Card #:
Exp. Date:
Comments:
Make checks payable to Medical Compliance Training and mail to: Medical Compliance Training PO Box 978 Hillsboro, TX 76645

All transactions are final. Funds may be applied toward any scheduled class within 2 years from date of registration.

BE SURE TO CLICK ON THE "Submit" BUTTON TO SEND THE INFORMATION
Close this window to return to the previous page.