Online Registration Form for Events and Programs

Submission of this online registration form does not guarantee registration in the class. You will receive an email or phone call to confirm your registration or notify you that the class is full. Please ensure you have received your class registration approval confirmation PRIOR to attending the class. If you do not receive an email or phone call please call us at: 315-464-8668 or 1-800-464-8668

To register for a class or event complete the form below. If you are registering multiple attendees please enter their names/addresses/phone numbers in the Other Attendees section.
Fields with * are required.

Event Name(s)*


Event Date(s)*


Your Name*


Your Professional Title (if any...i.e. RN, LPN)


Your E-Mail*(Required for confirmation of registration)


Your Phone Number* (Required in case of event cancellation)


Your Address* (Required for notification of future events)


Your Date of Birth


How did you hear about our program?*


Other Attendees
(Include Name, Address and Phone Number of each additional attendee. For each attendee indicate the event(s) they would like to attend.)

Comments
(Please include any additional comments here.)