Ace Online Class Registration Form

	Class Registration Form

Phone Numbers	Home: Work:
Your Name:
Address:
City, State, Zip:	,
E-Mail Address:
RN Paramedic Physician PA CRNA APN LPN Pharmacist Other:
Employer:

Course Selection:
Advanced Cardiac Life Support - Initial Certification Advanced Cardiac Life Support - Recertification Trauma Nurse Core Course - Initial Trauma Nurse Core Course - Recertification Pediatric Advanced Life Support - Initial Certification Pediatric Advanced Life Support - Recertification Basic 12 Lead EKG Interpretation Basic Rhythm Review Emergency Nursing Pediatric Course Dates of the course selected:
Need ACLS BOOK?: No Yes (Add $40.00)
BLS Option with ACLS course?: No Yes (Add $30.00)

Select Payment Method:
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Total Amount :
Credit Card Number :
Credit Card Expire Date :
Enter any questions or comments below:

Make checks payable to: ACE
Mail to: Academy for Career Enhancement
684 Fernwood Lane
Las Vegas, NV 89169
Phone 702-650-3600 - Fax 702-734-0879

Payment must accompany the registration form in order to assure class space. Refund requests will be subject to a $35.00 ($85.00 for TNCC, $125.00 for ENPC) cancellation fee. A no call no show will result in forfeiture of total fee. You must call prior to the date of the course
ACE reserves the right to cancel a course due to low enrollment. If this occurs the students will be sent a full refund.

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