Registration Form for
Certificate Program Information Session

Required Field
Last Name
First Name
Email
Day Phone
Evening Phone
Address
City
State	(i.e., CT)
Zip
Program of Interest	Select Program Central Sterile Processing Technician Diagnostic Medical Sonography Health Care Management (Online) Health Care Reimbursement Specialist Health Promotion (Online) Hospital Coding Specialist Human Services Medical Assisting Medical Office Assistant Multi-Skilled Assistant Pharmacy Technician RN Refresher
Information Session	--- Choose Date --- Thursday, May 15, 2008 at 5:30 P.M. Thursday, June 19, 2008 at 5:30 P.M. Thursday, July 17, 2008 at 5:30 P.M. Thursday, August 21, 2008 at 5:30 P.M. Thursday, September 18, 2008 at 5:30 P.M. Thursday, October 16, 2008 at 5:30 P.M. Thursday, November 20, 2008 at 5:30 P.M. Thursday, December 11, 2008 at 5:30 P.M.
# of People Attending	Select # 1 2 3 4 5 6 7 8
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