Last Name First Name Middle Initial
Home Address Apt No. City State
Zip
Mailing Address Apt No. City State Zip
Email Address: Fax No. (Area Code)Tele No..
Social Security No. Employer Telephone No.
Profession: Years Experience Months Experience
Organization/Registration/License No.( If Required)
Class Fee: 150.00, plus 4% surcharge for charge card usage.
Those
students taking option one will have a proctor fee. Procter fees are
assessed at the time of the examination.
Credit Card No. Bank
if registering with a Credit Card. Master Card Visa surcharge of 4% applies) Authorization for charges listed by:Full name on Card Expiration Full Signature
NO CASH PLEASE!!!!! Check Money Order
Check Option Choice:
Option 1 - Certificate of Completion/Serve Safe
Option 2 - National Certification/National Assessment Institute -
Both options are taught on the same format and are approved for Washoe Co. reciprocity. Reciprocity may be available for your local health department. Call Contact for information.
Fax, Mail, or Email transmission of this application indicates acceptance of financial
responsibility by the account holder in the amount designated for your class option style as
payment of fees for class materials, instruction, proctor fee, examination, and certificate.
A credit card name, /number and signature must be included for this registration with a credit option. Please add a 4% surcharge for credit card use. Do not send cash. Approved Company P.O., Check and Money Orders are accepted.. An access code will not be issued until class fees are received in full.
No fees will be refunded after the submission of lesson no. 1. All books are sent Airborne Express and must be returned via same, in new condition with no handwriting, etc. before any refunds will be made.
Handouts can be printed from Internet Access to this web page group.
Supplies required for project are the responsibility of the student to obtain. All materials and supplies are readily accessible at grocery stores, bookstores, or restaurant suppliers. If this class is employer paid, the very small quantities of supplies may be available form your employer. Please be sure to ask.
Reno Based Class Refund Schedule - No refunds of class tuition as a class space is held for
the student. If an emergency arises, the student my reschedule a class space in another
scheduled class. 48 hour notice of the need to reschedule is required.
Return to Table of Contents
Copyrighted material 7/97 Making Choices.... Stewart Enterprises
26