CFS Allied Health Education
Class Registration

Student Information
First Name Last Name
Address  
City
State/Prov Zip/Postal Code
Phone Fax
Email  

Credit Card Information
Name on Card:  
Credit Card #: Expiration: 3-4 Digit Security code
Billing Address  Billing Zip

Program Choice and Payment Amount

ABC Shoefitter 2-Day Live Class                             Location: 

Dates:

$395
ABC Shoefitter 8 Hours Online + 1-Day Live Class  Location:  Date:

$295
ABC Shoefitter 100% Online Distance Learning Program Select

$295

BOC Certified Orthotic Fitter Course                       Location: 

Dates:

$495
Assistive Technology  Exam Prep - Online Select

$149
DME Specialist Course - Online Select

$149
 I am an Orthofeet Customer  
  I am interested in a private class at my location. Total amount authorized to be charged to my card: 

100% Distance Learning students only:

I also understand that if I choose not to return the fitting kit within 30 days, this card will be charged an additional $250 .

I Agree

Comments: (List additional students here. Additional charges will apply.)
By submitting this form, I understand that I am not guaranteed a seat in the class selected until payment has been processed and the registration is confirmed. You will be contacted via phone or email for conformation of your registration within 48 hours.