Class Registration

Please fill out the following information OR print the following page and FAX or MAIL it to Infusion Knowledge, Inc. Please contact us if you have any questions or comments. Thank you!

Your e-mail address:

Your name:

Your Address:

City

State

Zip

Employer

Department

Title

Home Phone

Work Phone

Professional Designation

What class are you registering for?

Date(s)

Location

Amount

Comments

PAYMENT METHOD ?

A letter of confirmation will be sent to you within 7 days of receipt of your Registration Form.

Cancellation Policy

Infusion Knowledge must receive all cancellations in writing no later than 7 days prior to the course date; or a $50 processing fee will apply. We reserve the right to cancel any program if sufficient registrations are not received.