PN-NCLEX Review
North Point Plaza
1214 North Peterson Ave. Suite P
Douglas, GA 31533
Registration Form
PN-NCLEX Review
Course time is 8:30 a.m. to 4:30 p.m. Date January 16-17, 2010
*Participants:
Name: _____________________________________________________________
First Last
Address: ____________________________________________________________
Street City State Zip Code
Phone Number: ______________________________________________________
E-mail Address: ______________________________________________________
How did you hear about the Nursing Student Workshop or Review Course?
______________________________________________________________________
Student Registration fee: One time special offer for January 2010
Special Now Rate for Groups if Registered before December 28, 2009
( $135.00 In-house review comprehensive)
Method of Payment:
Credit Card/Debit Cashier’s Check Money Orders
(Circle One)
VISA or Mastercard
Credit card# _____________________________________________
Name on Card ___________________________________________
Expiration date on card: ___________________________________
Card Code to charge: _______________________
Please check if you require confirmation for your paid registration.
You may fax your registration to Ycarte Health Career Center @ 912-384-4390,
however, your money order must soon follow for complete registration or call to pay
using credit card.