Enrollment Form

© copyright 2008. Legal Nurse Consulting, Inc. All Rights Reserved.

Contact Us:
(704) 319-5516

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please print, fill, and fax this form to:

Fax: 704-319-5517

Click on HTML version for a better printout.
____________________________________________________________________________________________
Legal Nurse Consulting Center, Inc.
7810 Ballantyne Commons Parkway
Suite 300
Charlotte, North Carolina 28277


2008 APPLICATION

LEGAL NURSE CONSULTANT CERTIFICATE PROGRAM

Name: ______________________________________ Date: _________________

Address: ___________________________________________________________

City: __________________________________State______ Zip: _____________

E-Mail Address: __________________________ Phone: ___________________
We will never share your name with anyone nor ever send you any unwanted solicitations.
Name, address, email and phone Necessary for examination purposes.

Nursing License: _________ License in good standing w/ Bd of Nsg, LPN: Yes 0 No 0

Nursing Specialty (or Area of Practice): __________________________________

Legal Nurse Consulting Certification Program: $2350____ . Group Rate: $2010____. Silver Program (1 year Mentorship):
$3150____. Gold Program: $4550____. Ask about early sign-up rates for Gold and Silver Programs!

Basic Program:

  • $2,350.00 (Single Rate: 30-45 day Program)
  • $3,150.00 (Silver: 1-year of Mentorship Program)
  • $4,550.00 (Gold: Lifetime Mentorship Program)
  • $2,010.00 (Group Rate - 3 or More Students)

*Tuition includes all materials, books for complete 40-Day program.

Group Rates: Please contact LNC Center directly for information on group rates. (704) 319-5516. You may also email us at information@lnccenter.com

2008 Classroom Instruction commences:

  • ____ June 24-26: Boston , MA
  • ____ July 29-31: Chicago , IL
  • ____ August 12-14: Manhattan , NY
  • ____ August 26-28: Richmond , VA
  • ____ September 9-11: Long Island , NY
  • ____ September 23-25: Columbia, SC
  • ____ October 7-9: Ft. Lauderdale , FL
  • ____ October 14-16: Charlotte , NC
  • ____ October 28-30: Phoenix , AZ
  • ____ November 4-6: Web Teleconferencing
  • ____ November 11-13: Indianapolis, IN

_____ All applications/ deposit checks must be mailed to: Legal Nurse Consulting Center, 7810 Ballantyne Commons Parkway, Suite 300, Charlotte, North Carolina 28277. Credit card payment is now available on-line from our website at www.lnccenter.com, or by phone. Please contact us at (704) 319-5516 if assistance is needed.

Enclosed ____________ (50% DEPOSIT WITH REMAINING BALANCE TO BE PAID BEFORE LNC PROGRAM COMMENCES).

CANCELLATION POLICY FOR SEMINARS:

Full refund (minus $50 Registration Fee) with 7 or more days notice. IF CANCELLATION OCCURS 6 DAYS OR LESS, YOU MAY RECEIVE FULL TUITION CREDIT TOWARDS A FUTURE PROGRAM OFFERED, NO MONIES WILL BE REFUNDED.

* Live Web Conferencing Program or Home Certification Program requires 100% tuition payment plus shipping and handling prior to program. There is no refund once course materials are shipped to your residence.

____ I have read the above and agree to the terms. To the best of my knowledge all answers above are correct and true.

Signature__________________________________________________________________________

Office: (704) 319-5516
Fax: (704) 319-5517
ENROLLMENT FORM EMAIL US HERE. Register for your classes here. Email Us