EmailMe Form - Special Course Registration

Privacy Policy:

The information you provide on this form will be kept as securely as possible. It will never be sold to a third-party for marketing purposes.

Personal Information

Legal Name *

First Middle Last Suffix

Please enter your complete first, middle, and last names as they appear on your driver's license. Do NOT use initials. Enter "none" if you have no middle name.

Date of Birth *

MM / DD / YYYY

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Email *

Phone *

### - ### - ####

Please provide a number where you can be reached. Cell phone number is preferred.

Course Details

Enter the details of the course you would like to attend.

Course Title *

Date of Course *

MM / DD / YYYY

Enter the date of the first day of the course.

Payment Options *

All cash payments MUST be prearranged with one of our instructors. No exceptions. AMI Gift Certificates generally are not allowed as payment on Special Courses.

Notes

Registration Policy:

When you register for a course, we will email you a registration form and additional documentation in PDF format. Please read and follow the instructions on the email.

Your seat will not be held until we have received both your completed registration form and your payment for the course.

Special Registration Policy: *

All payments for ECQC are final. Refunds will only be issued for cancellation if a replacement can be found to fill your spot. Check here if you agree.

Registration Agreement *

I agree to the Registration Policy

By checking this box, you acknowledge that you are aware that your seat will not be reserved until your payment has been received.

Form ID Number